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Monitoring Access to
Care in New Hampshire’sMedicaid Program
Review of Key Indicators – June 2012 A Report Prepared by the Office of Medicaid Business and Policy
New Hampshire Department of Health and Human Services
Nicholas A. Toumpas, Commissioner
New Hampshire Department of Health and Human Services
Kathleen A. Dunn, MPH
Medicaid Director
Marilee Nihan,
M.B.A.
Medicaid Finance Director
June 22, 2012
The Department of Health and Human Services’ Mission is to join communities and families in providing opportunities for citizens to achieve health and independence
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
Acknowledgements
This report was written by the Office of Medicaid Business and Policy, New Hampshire Department of
Health and Human Services. Contributors include the following:
•
Andrew Chalsma,
Chief,
Bureau
of
Health
Care
Analytics
and
Data
Systems
• Farzana Alamgir, Senior Management Analyst
• Andrea Stewart, Business System Analyst
• Carolyn Richards, Business System Analyst
• Betsy Hippensteel, Administrator, New Hampshire Medicaid Client Services
• Valerie Brown, Senior Medicaid Business System Analyst
•
Robin Calley,
Program
Assistant
• Crystal Ingerson, Business Administrator
• Valerie Reed, University of New Hampshire
With assistance from:
• Jean Sullivan, Associate Vice Chancellor, University of Massachusetts, Center for Health Law and
Economics
• Deborah Bachrach, Manatt, Phelps & Phillips
• Melinda Dutton, Manatt, Phelps & Phillips
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
Table of Contents
1. Introduction 1
2. Methodology 5
3. Data and Analysis 9
New Hampshire Medicaid Beneficiaries 9
Provider Availability 15
Utilization of Services 18
Beneficiary Assistance and Satisfaction 43
Conclusion 46
4.
Beneficiary Engagement
47
New Hampshire Medicaid Client Services Unit 47
Medical Care Advisory Committee (MCAC) 49
Stakeholder Meetings 49
5. Plan for Monitoring Access 51
Updates to Monitoring 51
Investigation of Access Issues and Corrective Actions 51
Access Monitoring
under
Medicaid
Managed
Care
52
6. Summary and Conclusion 56
7. Appendices 58
Appendix A: New Hampshire Medicaid Community Health Center Access and Capacity 59
Appendix B: Tabular Version of Data in Trend Charts 61
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
1
1. Introduction
This report describes the New Hampshire Medicaid program’s overall system of healthcare‐access
measuring, monitoring,
and
intervention.
The
report
provides
data
measuring
the
adequacy
of
the
Medicaid provider network and level of provider availability, utilization of healthcare by Medicaid
beneficiaries over a five year period, as well as consumer perceptions of their ability to access care.
New Hampshire engages Medicaid beneficiaries through its consumer hotline as well as through its
Medical Care Advisory Committee and stakeholder meetings. Taken together, this data and analysis
show that New Hampshire Medicaid beneficiaries have access to healthcare that is similar to that of the
general population in New Hampshire. The data and analysis also demonstrate that New Hampshire
Medicaid beneficiaries have maintained similar levels of access since the implementation of the 2008
rate changes and the 2011 Disproportionate Share Hospital (DSH) payment changes.
This report
focuses
on
beneficiaries’
access
to
hospital,
physician,
and
clinical
care
services
and
not
on
the full range of New Hampshire Medicaid‐covered health care services. For example, data concerning
New Hampshire Medicaid beneficiaries’ access to behavioral health and long term care services are not
addressed in this report and will be the subject of future evaluations.
New Hampshire Medicaid provides coverage for low‐income children, pregnant women, parents with
children, elders, and people with disabilities. The New Hampshire Department of Health and Human
Services (DHHS) is the single State agency that administers the New Hampshire Medicaid program. New
Hampshire Medicaid covered all or part of the health care costs of more than 171,000 people during
State Fiscal Year 2011 (July 1, 2010 through June 30, 2011) for a total expenditure of $1.4 Billion.
New Hampshire
measures
and
monitors
indicators
of
healthcare
access
to
ensure
sufficient
Medicaid
beneficiary access to covered services. Pursuant to 42 U.S.C. 1396a(a)(30)(A), New Hampshire’s
Medicaid program must provide for methods and procedures relative to the utilization of and payment
for covered care and services as are necessary to safeguard against unnecessary utilization of care and
services and assure that payments are consistent with efficiency, economy, and quality of care. New
Hampshire must also ensure that payments are sufficient to enlist enough providers to provide care and
services to Medicaid beneficiaries at least to the extent that such care and services are available to the
general population in the geographic region. New Hampshire takes these obligations seriously and has
developed several mechanisms to assess and monitor beneficiary access.
No common
standards
exist
to
demonstrate
appropriate
healthcare
access
for
Medicaid
beneficiaries.
The Medicaid and Children’s Health Insurance Program Payment and Access Commission (MACPAC)
does provide guidance, however, on the issue of access in its March 2011 Report to the Congress.
MACPAC suggests a framework for examining healthcare access for Medicaid and CHIP beneficiaries.
The suggested framework has three main elements: beneficiaries and their unique characteristics,
provider availability for the Medicaid and CHIP populations, and utilization of available healthcare
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M
N
Of
ONITORING ACCES
w Hampshire De
fice of
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New Ham
and unins
enrolled i
Approxim
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Figure 1.
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and 70 m
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DICATORS, JUNE 2
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
3
State of New Hampshire, set forth below, for a depiction of the State, and location of hospitals, FQHCs
and RHCs.
Map provided by DHHS/DCBCS/BBH/jh03/15/2012C:\MedicaidMapping\MedicaidSFY2011AnnualReport\PrimaryCare.mxd
Number of Medicaid EnrolleesWith Location of Hospitals
and Affiliated Practices,FQHCs, and RHCs
Medicaid Enrollees863 - 999
1,000 - 4,999
5,000 - 9,999
10,000 - 25,844
Hospitals/Hospital-Affiliated Primary Care
FQHC/RHC
Non-Metro Counties
Metro Counties
0 4020 Miles
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
4
In this report, New Hampshire Medicaid examines Medicaid beneficiary access to physician and clinic
healthcare services by documenting data and trends in three distinct areas: 1) provider and clinic
availability, and 2) utilization of healthcare services by Medicaid beneficiaries, and 3) beneficiary needs.
The data
and
analysis
set
forth
in
Chapter
Three
of
this
report
establish
the
historical
and
current
access
levels for these focal areas through analysis of trends from 2007 through 2011 and includes control
charts and statistical tests. New Hampshire Medicaid uses this analysis to systematically evaluate and
monitor New Hampshire Medicaid beneficiaries’ access to health care, as well as to provide for an early
warning system for access disruptions. Evidence of ongoing beneficiary engagement is included and
evaluated as well. Systematic, data‐driven access monitoring plans, based on key indicators chosen to
evaluate access, as well as planned procedures for corrective action should access problems arise, form
the basis of New Hampshire Medicaid’s access measuring and monitoring framework.
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
5
2. Methodology
Information
published
by
MACPAC
was
used
as
the
primary
source
of
material
for
developing
New
Hampshire Medicaid’s framework for evaluating healthcare access. New Hampshire Medicaid’s analysis
of healthcare access follows MACPAC’s recommended three‐pronged approach: beneficiary
characteristics, provider capacity, and service utilization rates. In addition, New Hampshire adds a forth
prong: beneficiary assistance and satisfaction.
First, New Hampshire Medicaid evaluated the unique characteristics of New Hampshire Medicaid
beneficiaries. Using retrospective data analysis, New Hampshire Medicaid documented the size of the
Medicaid population, demographics, enrollment data, trends in enrollment, and geographic dispersion.
This was performed to provide a clear picture of the population, their healthcare needs, and the context
for evaluating New Hampshire Medicaid’s network of providers.
The second prong of New Hampshire Medicaid analysis focuses on evaluating the adequacy of the New
Hampshire Medicaid provider network. Evaluating provider network capacity entails determining
whether the number of providers, i.e. physicians, physician groups, clinics, and hospital emergency
departments afford sufficient capacity for the Medicaid patient load in New Hampshire. New
Hampshire Medicaid used provider enrollment and enrollment trends to evaluate physician and
provider adequacy in New Hampshire.
The third prong of New Hampshire’s access evaluation framework is an analysis of healthcare service
utilization data and trends. Service utilization by Medicaid beneficiaries represents realized access.
Realized access
refers
to
how
New
Hampshire
Medicaid
beneficiaries
are
actually
using
available
healthcare services. New Hampshire focuses on utilization statistics by age, geography, and eligibility
group. New Hampshire Medicaid examines how patterns of healthcare service use differs among
eligibility groups, age groups, and geographic regions; how healthcare service venue has changed; and
how healthcare service use trends have changed over time, particularly over the period of time before
and after New Hampshire reduced reimbursement rates paid to non‐critical care hospitals and made
other changes to hospital payment arrangements, including DSH. New Hampshire Medicaid extracted
data for the period of 2007 through 2011. Data on healthcare service utilization was interpreted
generally by comparing New Hampshire Medicaid utilization over time.
New Hampshire Medicaid compiled eligibility and administrative claims data for five years of FFS paid
claims reflecting services used by Medicaid beneficiaries. New Hampshire Medicaid compiled service
utilization statistics for physicians, for APRNs, for FQHCs and RHCs. These provider utilization rates were
calculated per 1,000 Medicaid beneficiaries.
D a t a S o u r c e s
Membership, utilization, and active provider reports are based on data extracted from the New
Hampshire’s Medicaid Management Information System (MMIS), the state’s Medicaid claims processing
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
6
system. Inherent in this data are differences in coding practices across providers, which potentially
affect results and contribute to observed differences. Client Services Call Center data is based on data
extracted from the Call Center’s call tracking database.
P o p u la t io n I n c lu d e d i n T r e n d D a t a
The populations
included
in
the
member
and
utilization
trend
data
are
those
beneficiaries
for
whom
New Hampshire Medicaid provides the only known sole source of general health care coverage.
Beneficiaries with Medicare or other health coverage are excluded because for these groups New
Hampshire Medicaid only plays a secondary role in providing general health coverage and as a result
does not have complete claims data. Reports on an annual timespan (or in the case of the well‐baby
visit measure, the first fifteen months of life) only include those beneficiaries continuously enrolled
during the period, with no more than a one month gap to allow for consistency with national measure
specification standards.
S e r vic e D a t e P e r i o d s a n d Cla i m s R u n -o u t
All utilization reports are based on date of service for time periods, either calendar years or calendar
year quarters. In order to provide a consistent basis for comparing reports over time, it was necessary
to also provide consistent claims run‐out for each reporting period. Quarterly measures are based on
three months of claims run‐out (e.g., if the service period being reported covers January to March 2011,
the report will include all claims paid through June 30, 2011). While some additional claims will be paid
after that service date, by keeping the restriction consistent from period‐to‐period the trend will not be
impacted. Annual measures are based on a longer run‐out period of six months to make them more
comparable to national benchmarks that are generally based on the same period (six months ensures
greater than 99% of claims have been processed).
G e o gr a p h ic Gr o u p i n g
Beneficiaries are subdivided geographically based on their county of residence. New Hampshire is
divided into those counties that are Metropolitan and those that are Non‐Metropolitan based on USDA
rural/urban continuum codes. Metropolitan counties are Hillsborough, Rockingham, and Strafford and
the Non‐Metropolitan counties are Belknap, Carroll, Cheshire, Coos, Grafton, Merrimack, and Sullivan.
The counties in both groupings are contiguous. As of 2011, the Metropolitan area includes 57% of
beneficiaries that have an in‐state address. A small number of beneficiaries with out‐of ‐state address
are excluded from the geographic groupings, but included in all other reporting. Outlines of the two
areas are included in the map on page 3.
Age an d El ig ib i l ity Grou pin g
Beneficiaries are
subdivided
based
on
their
age
and
aid
category
of
assistance
during
each
month
of
a
quarter or for annual data, the last date of the reporting period. Data for most trends is reported using
the following groupings (age and aid categories used in parenthesis):
• Children (age less than 19):
- Blind and Disabled (Aid to Needy Blind and Home Care for Children with Severe Disabilities),
- Families and Children (TANF and Poverty Level Children), and
- Foster Care (Foster Care and Adoption Subsidy).
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
7
• Adults (age 19 and older):
- Aged (Old Age Assistance),
- Blind and Disabled (Aid to Needy Blind, Aid to Permanently and Totally Disabled, Medicaid
for Employed Adults with Disabilities), and
- Families and Children (TANF and Poverty Level Pregnant Women).
Data for
well
‐child
visit
measures
use
the
age
groupings
as
specified
by
the
National
Committee
for
Quality Assurance (NCQA). Data for the measure that examines what percent of children during the
year had a preventive or other ambulatory health service is designed to look at how this measure varies
by refined age breakdowns of children (less than age 1, age 1, age 2, age 3 to 4, age 5 to 9, age 10 to 14,
age 15 to 17, and age 18 to 20).
Con t r o l L i mi t s
Control limits are employed in quarterly trend charts to provide a consistent indication of a potential
access problem as each new quarter of data is available. Control limits are set as three standard
deviations (following conventional practice) from the mean based on Quarter 1 2007 to Quarter 3 2011
data.
Because it
is
the
principal
time
period
analyzed
in
this
report,
the
final
Quarter
of
2011
was
excluded from the calculation of the control limits. Control limits were set before analyzing the data.
Future updates to this report will maintain the same control limits until such time that a rebasing is
needed in response to shifts in health care delivery, the health of the population, or changes in available
data.
Depending on the measure, a rate for a time period below the lower control limit or above the upper
limit is the trigger indicating a potential access problem requiring further investigation. Additionally, a
persistent trend above or below the mean line would warrant further research.
Con fi den ce I n t e r va ls
For charts based on annual data, control limits are not presented (annual data does not provide enough
experience for meaningful limits). Instead, 95% confidence intervals are presented. The confidence
interval takes into account random variability in the data to allow for comparison of rates over time.
The 95% confidence interval is the range of values that, with 95% certainty includes the underlying rate
for the entire population. As the number of beneficiaries represented in the rate increase, the
confidence intervals become narrower.
The 95% confidence interval is computed using the following formulas:
Lower limit = p – [1.96 x (p*q/B)]
Upper limit = p + [1.96 x (p*q/B)]
Where b = denominator; p = percent divided by 100; and q = 1- p
If the current period of data deviates to such a degree that its confidence interval does not overlap with
the prior period’s confidence interval it will indicate a potential access problem requiring further
investigation. Additionally, if a slowly declining trend is observed and the current period’s confidence
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
8
interval does not overlap with any of the previous three confidence intervals it will indicate a potential
access problem requiring further investigation.
S m a l l N u m b e r s
Because New Hampshire is a small State, it is necessary to take into account the volume of data
available for
reporting.
For
some
combinations
of
age
and
eligibility,
the
volume
of
data
is
too
small
to
allow for meaningful reporting. Rates based on smaller numbers are more volatile due to random
variation. To account for this volatility, control limits and confidence intervals must be wider, rendering
them less meaningful.
M a jo r R e im b u r s e m e n t Ch a n ge s
Four New Hampshire Legislative changes in Medicaid payment levels in recent years are relevant to this
report’s access measures and trend analyses: inpatient and outpatient hospital services rate reductions
and Disproportionate Share Hospital (DSH) methodology and payment restructuring. In December 2008,
DHHS reduced Medicaid reimbursement rates paid to New Hampshire’s 13 non‐critical access hospitals
for outpatient services by approximately 33%. New Hampshire reduced Medicaid inpatient
reimbursement rates for non‐critical access hospitals by 10% effective December 1, 2008. New
Hampshire Medicaid DSH program methodology was revised in December 2010 to pay higher rates of
reimbursement for the uncompensated care costs of critical access hospitals, while still making a DSH
payment to all but one psychiatric hospital in the State. In December 2011, DSH qualifying criteria were
restructured to make payments available almost exclusively to critical access and “deemed DSH”
hospitals, and the total amount of funding for DSH payments statewide was reduced. The potential
impacts of these changes are considered in this report from the standpoint of healthcare access and
access trend analysis by representing the changes on quarterly utilization trend charts.
Description of Change Implementation Date
Outpatient Rate
Reductions
for
13
acute care
non
‐
critical access hospitals December 2008
Inpatient Rate Reductions for 13 acute care non‐
critical access hospitals December 2008
Revision of DSH Methodology December 2010
Reduction in total DSH Funding December 2011
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
9
3. Data and Analysis
The
sections
in
this
chapter
present
New
Hampshire
Medicaid
trend
information
on
areas
related
to
access to health care services. The trend data is divided into the following sections:
• New Hampshire Medicaid Beneficiaries,
• Availability of Provider Network,
• Utilization of Services, and
• Beneficiary Assistance and Satisfaction.
Data throughout is presented as five‐year trends. Depending on the measure, information is presented
quarterly or annually. Annual measures are restricted to those where the national standard definition is
annual, typically to account for services that are expected take place a certain number of times over an
annual period
(e.g.,
well
child
visits).
To
maintain
the
clarity
of
the
charts,
as
new
periods
of
data
are
available, the oldest period of history will be rolled off the reports.
Accompanying the data are indications of the major payment changes impacting the health system
being analyzed.
Beyond presenting the data in a visual form, the charts also include analytic tools that provide a defined
trigger indicating a potential access problem requiring further research. Quarterly data are presented
along with control limits and annual data (where the data is insufficient to support control limits) with
confidence intervals. Correlations between the payment changes and the trend data that appear to
exist will help inform any further research needed.
The focus of the data presented is general medical physician/APRN/group/clinic and hospital services.
Ne w Ha m p sh i r e M e d i ca i d Be n e fi cia r ie s
Over v i ew o f New H am ps h i r e Med i ca i d Bene f ic ia r i e s
New Hampshire Medicaid program Beneficiaries are made up of the following mandatory and optional
eligibility categories listed in below.
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
10
Mandatory Eligibility Groups * • Low‐income Medicare beneficiaries
• Individuals who would qualify for Temporary Assistance to Needy Families (TANF) today under the
state’s 1996 AFDC eligibility requirements†
• Children
under
age
six
and
pregnant
women
with
family
income
at
or
below
133%
of
federal
poverty level (FPL) guidelines
• Children born after September 30, 1983, who are at least age five and live in families with income
up to the FPL
• Infants born to Medicaid‐enrolled pregnant women
• Children who receive adoption assistance or who live in foster care, under a federally‐sponsored
Title IV‐E program
• Low‐income aged, blind, and disabled receiving State supplemental assistance
Optional Eligibility Groups‡ • Children and pregnant women up to 185% of the FPL, and infants up to 300% of the FPL (in the
process of
being
expanded
to
300%
of
the
FPL
for
all
children
by
conversion
of
New
Hampshire’s
separate CHIP program to a Medicaid expansion program).
• Individuals determined to be “medically needy” due to large medical expenses§
• Home Care for Children with Severe Disabilities (HC‐CSD), commonly known as “Katie Beckett”; for
severely disabled children up to age 19 whose medical disability qualifies them for institutional care
but are cared for at home
• Medicaid for Employed Adults with Disabilities (MEAD) allows Medicaid‐eligible disabled individuals
between the ages of 18 and 64 who want to save money or work to increase their earnings while
maintaining Medicaid coverage (up to 450% FPL)
New Hampshire Medicaid beneficiaries tend to have a higher burden of illness than privately insured
individuals. They are twice as likely to have asthma, coronary artery disease, hypertension, depression,
and mental health disorders (particularly children); they are three to four times more likely to suffer
from a stroke or Chronic Obstructive Pulmonary Disease or to use hospital emergency rooms; and five
times as likely to have lung cancer or heart failure (New Hampshire Medicaid Annual Report, 2011).
The two figures below show the distribution of beneficiaries by age, eligibility group, and gender as of
June 2011.
* In 1974, New Hampshire, like over thirty other states at the time, elected for the “209(b)” status provided in the federal law that created the
Supplemental Security Income (SSI) program (the federal income assistance program for disabled, blind, or aged individuals). When creating the
SSI program, Congress hoped that SSI beneficiaries would also receive Medicaid. However, Congress was mindful of the increased expense for
states
to
automatically
cover
all
SSI
beneficiaries.
To
provide
states
some
financial
flexibility,
the
209(b)
option
was
crafted
which
allowed
a
state to be more restrictive in its Medicaid eligibility than the SSI program eligibility guidelines, so long as those methodologies were no more
restrictive than methodologies in place on January 1, 1972. Accordingly, New Hampshire does not automatically grant Medicaid to SSI
beneficiaries. SSI beneficiaries who desire Medicaid must qualify for a state defined category of assistance.
† In 1996, federal policymakers severed the tie between medical and cash assistance when the AFDC program was replaced. The AFDC standard
was retained in Title XIX to prevent the states from using the more restrictive eligibility requirements and time limits of AFDC’s successor–
Temporary Assistance for Needy Families or TANF–when providing Medicaid coverage to needy children and families.
‡ The ACA extended ARRA eligibility maintenance of effort (MOE) requirements for adults until 2014 and for children until 2019.
§ While Medically Needy is an optional category, as a 209(b) State, if New Hampshire does not elect to provide medically needy coverage, we
must allow adult category individuals whose income exceeds the categorically needy income limit to spend down to the categorically needy
income limit. Additionally, once a State opts to provide medically needy coverage, there are certain groups that must be covered as medically
needy (e.g., pregnant women).
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M
N
Of
ONITORING ACCES
w Hampshire De
fice of
Medicaid
B
Children (
shown be
members
Females
eligibility
eligibility
elderly (7
only grou
severely
Figure 2.
The figur
figures o
those me
focus of t
third part
beneficia
New H
This secti
beneficia
members
Data is pr
broken o
Age 19‐6
30.7%
TO CARE IN NEW
artment of Healt
usiness and
Polic
members 18
low, benefici
aged 65 plu
ccount for o
categories w
category and
%, due to lo
ps in which
isabled child
NH Medic
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mbers know
his report is
ies, not New
ies are the s
a m p s h i r e
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ies. The dat
.
esented for t
t for metrop
4
Age 65+
9.5%
HAMPSHIRE’S MED
h and Human Serv
years or less
aries age 19
.
er half of M
ith females
p
greater likel
nger lifespan
ales make u
groups.
aid Beneficia
, June 2011
based on the
and later fig
to have oth
hysician and
Hampshire
bject of the
Medica id
end in avera
a in the figur
he total Med
olitan and n
ICAID PROGRAM:
ices
) make up 60
o 64 repres
dicaid bene
redominatinihood of hea
and likeliho
p a larger pr
ries by Age
entire Medi
res showing
er medical in
hospital car
edicaid, for
following re
Benef ic i
e monthly e
s will be up
icaid popula
n‐metropoli
Age 0‐18
59.8%
REVIEW OF KEY IN
% of the Ne
nt 31% of be
iciaries. Ge
low
‐income
ing single p
d of fewer r
portion of b
Figure
aid beneficia
utilization tr
surance. Th
, and care f
these benefi
orting.
a r y En r o l
rollment by
ated quarte
ion, broken
an areas of t
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
DICATORS, JUNE 2
Hampshire
neficiaries a
der differen
adults
(84%
rent low‐inc
esources tha
neficiaries a
. NH Me
and Elig
ry populatio
ends, exclud
beneficiarie
r those servi
iaries. Appr
lm e n t T r
quarter of N
ly. Utilizatio
ut by age an
he State.
4 4 % 5
2 %
1 6 %
5 6 %
4 8 %
T o t a l
L o w I n c o m e C h i l d
12
Medicaid po
d the remai
es are obser
, due
to
preg
ome househ
n males). As
re the low‐in
icaid Benefi
ibility Categ
n. However,
e Medicare d
s are exclude
ces is nearly
oximately 10
n d s
ew Hampshi
n trends are
d eligibility g
6 6 %
4 8 %
8 4 %
3 4 %
L o w I n c o m e A
u t
S e v e
r e l y D i s a b l e d C h i l d
A d u l t s w / P
h y s i c a l D i s a b i l i t i e s
Mal
ulation. As
ing 10% are
ved in all
nant women
lds) and the
shown belo
come child a
iaries by Ge
ry, June 201
the followin
ually eligible
d because th
always paid f
0,000
e Medicaid
racked for t
roupings, an
4 7 %
2 6 %
5 3 %
7 4 %
A d u l t s w / M e n t a l I l l n e s s
D i s a b i l i t i e s E
l d e r l y
e Female
11
, the
nd
nder
1
s, and
e
or by
ese
3 8 %
6 2 %
S L M B / Q M B
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
12
The figures show a very gradual rise in enrollment in 2007 and 2008, followed by more rapid increase in
2009 due to the recession, with a slight rise thereafter. In 2011, there was a less than 1% increase in
total enrollment.
As the largest group by far, enrollment for the Families and Children eligibility groups was similar to the
total.
However, the
adults
in
this
group
have
seen
a decrease
in
enrollment
throughout
2011.
Figure 4. NH Medicaid Enrollment, CY 2007‐2011: Total Population
Note: excludes Medicare dually eligibles and members with other medical insurance
82,880
100,675
0
20,000
40,000
60,000
80,000
100,000
120,000
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Average Members
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
13
Figure 5. NH Medicaid Enrollment, CY 2007‐2011: Child, Families and Children Eligibility Group
Note: excludes Medicare dually eligibles and members with other medical insurance
Figure 6. NH Medicaid Enrollment, CY 2007‐2011: Child Foster Care and Blind and Disabled
Population
Note: excludes Medicare dually eligibles and members with other medical insurance
60,041
73,447
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Families and Children
522606
1,935
1,668
0
500
1,000
1,500
2,000
2,500
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Blind and Disabled Foster Care
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
14
Figure 7. NH Medicaid Enrollment, CY 2007‐2011: Adult Population by Eligibility Group
Note: excludes Medicare dually eligibles and members with other medical insurance
Figure 8. NH Medicaid Enrollment, CY 2007‐2011: Metropolitan and Non‐Metropolitan Counties Note: excludes Medicare dually eligibles and members with other medical insurance
672 902
7,080
9,953
12,630
14,098
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Aged Blind and Disabled Families and Children
45,220
56,778
35,115
42,687
0
10,000
20,000
30,000
40,000
50,000
60,000
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Metro Counties Non Metro Counties
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M
N
Of
ONITORING ACCES
w Hampshire De
fice of
Medicaid
B
P r o v i
The provi
beneficia
of benefi
Physic i
All of Ne
New Ham
Medicaid
general p
the gener
some co
care site
With rega
enrollmephysician
of this br
which als
in their p
million p
physician
physician
Figure 9.
Active
Obs t e t
The follo
one claim
limits at t
TO CARE IN NEW
artment of Healt
usiness and
Polic
e r Ava i
der availabili
ies. Measur
iaries to acti
a n a n d H
Hampshire’
pshire Medi
beneficiarie
opulation, an
al patient po
munities, th
or commerci
rd to physici
t by
license
s are also Ne
ad overlap,
explains w
nel (as com
ople, and a t
, while there
s for a ratio
Active NH
Billing
Ad
r i m a r y
i c i ans / G
ing three fig
in the quart
he third stan
HAMPSHIRE’S MED
h and Human Serv
labi l i ty
y section foc
es are includ
ve providers.
osp i t a l P
s 26 acute ca
aid and activ
share the sa
d the distrib
pulation. Th
e local comm
ally insured
ans, Figure 9
active provi
Hampshire
atios of New
y most indivi
ared to mor
otal of 4,047
are 0.1 millio
f 26 people
Medicaid In‐
ress,
2012
a r e P r o v
necologi
ures show th
r). Major N
dard deviatio
Active No
Medicai
Provider
6%
ICAID PROGRAM:
ices
uses on whe
d on provid
The data in
r t i c i pa t i
re hospitals
ely provide s
me hospital
tion of Med
re are no pu
unity health
atients, as w
provides inf
ders. As
can
Medicaid pr
Hampshire
dual practiti
populous o
licensed pra
n Medicaid
er physician
State Physic
i d e r s , P e d
s t s
e trend in th
w Hampshir
n of the hist
n‐
s
REVIEW OF KEY IN
ther healthc
r participati
the figures w
n
s well as tw
ervices. In c
nd health ce
icaid patient
blic “safety
centers (FQ
ell as Medic
rmation on t
be seen,
nea
oviders (data
edicaid ben
ners will lik
r urban state
ticing physic
eneficiaries
for the New
ian Provider
i a t r i c i an
e ratio of be
e Medicaid p
rical data ar
DICATORS, JUNE 2
re services a
n in New Ha
ill be update
of three sp
ntrast to m
nter networ
utilization of
et” hospital
C or RHC) se
id and unins
he most rec
rly all
(94%)
source: NH
eficiaries to
ly have smal
s). For exam
ians for a rat
and a total o
Hampshire
Compared
s , a n d
eficiaries to
ayment chan
e included to
Active
Medicaid
Providers
94%
12
re accessible
mpshire Me
d quarterly.
cialty hospit
ny states, N
(or delivery
these faciliti
in New Ham
rve as the pri
ured individu
ntly availabl
f licensed
pr
Board of Me
active provid
l numbers of
ple, New Ha
io of 321 pe
3,793 active
edicaid pop
o Licensed P
active provid
ges are indic
provide a tri
to Medicaid
icaid and ra
als are enroll
w Hampshir
system) as t
s is also sim
pshire, and i
mary ambul
als.
data on
acticing
icine). Beca
ers are very
Medicaid pa
pshire has
ple per licen
(billing)
lation time.
roviders Wit
ers (those wi
ated and con
gger indicati
15
ios
ed in
e’s
e
ilar to
n
tory
use
igh,
tients
.3
sed
h NH
th
trol
g a
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
16
potential access problem requiring further investigation. For the ratios presented, exceeding the upper
control limit would indicate a potential problem.
The rates shown in all figures do not cross the upper control limit, and therefore do not indicate a
potential access problem at this time, nor is there evidence of an impending access problem based on
current data.
The
primary
care
trend
has
shown
consistent
improvements
during
the
past
several
quarters. The trend in ratios of beneficiaries to pediatricians and obstetricians/gynecologists while
stable since 2008, are larger compared to 2007. This change was due entirely to growth in enrollment.
Figure 10. Ratio of NH Medicaid Beneficiaries to Active In‐State Primary Care Providers (Internal
Medicine, Family Practice, General Practice, Pediatricians), CY 2007‐2011
38
36
46
Hospital Rate Reductions DSH ReductionDSH Redesign
0
5
10
15
20
25
30
35
40
45
50
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Beneficiaries per Provider Mean Rate Control Limit
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
17
Figure 11. Ratio of NH Medicaid Child Beneficiaries to Active In‐State Pediatricians, CY 2007‐2011
Figure 12. Ratio of NH Medicaid Adult Female Beneficiaries Age 18 to 64 to Active In‐State
Obstetricians/Gynecologists, CY 2007‐2011
268
235
294
Hospital Rate Reductions DSH ReductionDSH Redesign
0
50
100
150
200
250
300
350
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Beneficiaries per Provider Mean Rate Control Limit
329
270
377
Hospital Rate
Reductions DSH
ReductionDSH
Redesign
0
50
100
150
200
250
300
350
400
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Beneficiaries per Provider Mean Rate Control Limit
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
18
Avai lab i li ty of Cap aci ty a t H eal th Cen ter s
In addition to ongoing assessment of provider participation, New Hampshire Medicaid has begun to
undertake periodic assessment of the available capacity of providers to accept new patients on their
panels. The first of these assessments was performed for Federally Qualified Health Centers (FQHC),
FQHC Look‐a‐Likes, and Non‐FQHC Community Health Centers. The majority of the centers that
responded to
inquiries
reported
having
available
capacity
to
take
on
hundreds
of
new
patients
each.
The complete result of this assessment is provided in the Appendix A.
Uti liza t ion of Ser v ices
Appropriate health care utilization is the ultimate outcome of achieving effective health care access.
Studying healthcare utilization patterns can provide a signal that a particular subgroup or region of the
State may have an access issue.
Quarterly key physician and hospital utilization trends with control limits and annual utilization of
preventive and
office/clinic
health
services
trends
are
presented.
Data
is
broken
out
by
age
and
eligibility groupings, and broken out for metropolitan and non‐metropolitan areas of the State (to take a
special look at areas with a greater sensitivity to access problems). The data in the figures will be
updated quarterly or annually as appropriate.
All trends are based on administrative eligibility and claims data. Inherent in these data are differences
in coding practices across providers, which potentially affect results and contribute to observed
differences.
Qua r ter ly Ben ef ic ia r y Ut il iza t ion An alys is
Figures in this section show the trend in quarterly use of key physician and hospital services by New
Hampshire Medicaid
beneficiaries
as
indicated
by
Medicaid
claims
data*.
The
data
in
the
figures
will
be
updated quarterly.
Rates are the number of visits in the quarter divided by the number of beneficiary months for the
quarter times 1,000.
Major New Hampshire Medicaid payment changes are indicated and control limits at the third standard
deviation of the historical data are included to provide a trigger indicating a potential access problem
requiring further investigation.
Detail is presented below on:
• Physician/APRN/Clinic Utilization,
• Emergency Department Utilization for Conditions Potentially Treatable in Primary Care,
• Total Emergency Department Utilization,
• Inpatient Hospital Utilization for Ambulatory Care Sensitive Conditions, and
*Excluding Medicare dually eligibles, and those members known to have other medical insurance as their physician care is nearly always paid
for by third parties, not NH Medicaid.
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
19
• Total Inpatient Hospital Utilization.
In all cases, no control chart indicates a potential access issue requiring further research. However, as
noted in each section below, some charts exhibit persistent trends that will be researched and reported
on in the next issue of this report.
Season a l ly Ad j us t ed Phy s i ci an / APRN / C li n i c Ut i li za t i on
Figures in this section show the trend in quarterly use of physician, APRN, FQHC, and RHC services by
New Hampshire Medicaid beneficiaries as indicated by Medicaid claims data.
Data is presented for the total Medicaid population, broken out by age and eligibility groupings, and
broken out for metropolitan and non‐metropolitan areas of the State.
The data presented has been adjusted to remove seasonality that in New Hampshire reliably results in
higher than average rates in the first calendar quarter and lower than average rates in the third calendar
quarter (due to seasonality of respiratory infections).
For the physician, APRN, FQHC, and RHC utilization measure, a rate below the lower control limit is the
trigger indicating a potential access problem requiring further investigation.
The rates shown in all figures never cross the lower control limit, and therefore do not indicate a
potential access problem.
Figure 13. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Total Population
368
332
413
Hospital Rate Reductions DSH ReductionDSH Redesign
0
50
100
150
200
250
300
350
400
450
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
20
Figure 14. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Children, Blind and Disabled Aid Categories
Figure 15. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Children, Children and Families Aid Categories
476
336
530
Hospital Rate
Reductions DSH
ReductionDSH
Redesign
0
100
200
300
400
500
600
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
316
286
346
Hospital Rate Reductions DSH ReductionDSH Redesign
0
50
100
150
200
250
300
350
400
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
Page 24
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
21
Figure 16. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Children, Foster Care Aid Categories
Figure 17. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Adults, Aged Aid Categories
329
276
381
Hospital Rate
Reductions DSH
ReductionDSH
Redesign
0
50
100
150
200
250
300
350
400
450
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
584
433
674
Hospital Rate Reductions DSH ReductionDSH Redesign
0
100
200
300
400
500
600
700
800
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
Page 25
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
22
Figure 18. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Adults, Blind and Disabled Aid Categories
Figure 19. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Adults, Families and Children
568
473
676
Hospital Rate
Reductions DSH
ReductionDSH
Redesign
0
100
200
300
400
500
600
700
800
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
478449
576
Hospital Rate Reductions DSH ReductionDSH Redesign
0
100
200
300
400
500
600
700
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
23
Figure 20. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Metropolitan Areas
Figure 21. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Non‐Metropolitan Areas
391
354
443
Hospital Rate
Reductions DSH
ReductionDSH
Redesign
0
50
100
150
200
250
300
350
400
450
500
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
346
322
402
Hospital Rate Reductions DSH ReductionDSH Redesign
0
50
100
150
200
250
300
350
400
450
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
24
S e a s o n a l ly A d j u s t e d E m e r g e n c y D e p a r t m e n t U t i li z a t io n f o r Co n d i t i o n s
P o t en t i a l ly T r e a t a b l e in P r im a r y Ca r e
Figures in this section show the trend in quarterly use of hospital emergency departments for conditions
that might have been more appropriately treated in primary care (e.g., upper respiratory infections) as
indicated by Medicaid claims data.
Data is presented for the total Medicaid population, broken out by age and eligibility groupings, and
broken out for metropolitan and non‐metropolitan areas of the State where supported sufficient data
needed for reliable results.
The data presented has been adjusted to remove seasonality that in New Hampshire reliably results in
higher than average rates in the first calendar quarter and lower than average rates in the third calendar
quarter (due to seasonality of respiratory infections).
For this measure, a rate above the control limits is the trigger indicating a potential access problem
requiring further investigation. Higher rates, in conjunction with lower use of primary care could
indicate an
access
problem.
The rates shown in all figures never cross the control limits, and therefore do not indicate a potential
access problem.
Figure 22. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Total
Population
19
15
22
Hospital Rate Reductions DSH ReductionDSH Redesign
0
5
10
15
20
25
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
Page 28
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
25
Figure 23. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Children,
Children and Families Aid Categories
Figure 24. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Adults,
Blind and Disabled Aid Categories
17
12
21
Hospital Rate Reductions DSH ReductionDSH Redesign
0
5
10
15
20
25
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
25
20
32
Hospital Rate Reductions DSH ReductionDSH Redesign
0
5
10
15
20
25
30
35
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
Page 29
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
26
Figure 25. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Adults,
Children and Families Aid Categories
Figure 26. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011:
Metropolitan Areas
26
22
31
Hospital Rate Reductions DSH ReductionDSH Redesign
0
5
10
15
20
25
30
35
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
19
13
22
Hospital Rate Reductions DSH ReductionDSH Redesign
0
5
10
15
20
25
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
Page 30
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
27
Figure 27. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Non‐
Metropolitan Areas
S e a s o n a l ly A d j u s t e d T o t a l Em e r g e n c y D e p a r t m e n t U t i li za t i o n
Figures in this section show the trend in quarterly use of hospital emergency departments by New
Hampshire Medicaid beneficiaries as indicated by Medicaid claims data.
Data is
presented
for
the
total
Medicaid
population,
broken
out
by
age
and
eligibility
groupings,
and
broken out for metropolitan and non‐metropolitan areas of the State.
The data presented has been adjusted to remove seasonality that in New Hampshire reliably results in
higher than average rates in the first calendar quarter and lower than average rates in the third calendar
quarter (due to seasonality of respiratory infections).
For the total emergency department utilization measure, a rate either above or below the control limits
is the trigger indicating a potential access problem requiring further investigation. Higher rates, in
conjunction with lower use of primary care could indicate an access problem. Rates below the control
limit
could
indicate
more
appropriate
use
of
care
(a
goal
of
the
program),
but
would
still
be
investigated
if provider enrollment data indicates the potential for reduced emergency department access.
As shown below, the data indicates that emergency utilization has not crossed the control limits and
supports the conclusion that Medicaid beneficiaries in New Hampshire do not have a problem accessing
healthcare services.
18.15
16
26
Hospital Rate Reductions DSH ReductionDSH Redesign
0.00
5.00
10.00
15.00
20.00
25.00
30.00
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
Page 31
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
28
Figure 28. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Total Population
Figure 29. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Children, Blind and Disabled Aid Categories
70
61
81
Hospital Rate
Reductions DSH
ReductionDSH
Redesign
0
10
20
30
40
50
60
70
80
90
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Rate per 1,000 Mean Rate Control Limit
53
39
77
Hospital Rate Reductions DSH ReductionDSH Redesign
0
10
20
30
40
50
60
70
80
90
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
Page 32
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
29
Figure 30. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Children, Children and Families Aid Categories
Figure 31. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Children, Foster Care Aid Categories
53
42
62
Hospital Rate
Reductions DSH
ReductionDSH
Redesign
0
10
20
30
40
50
60
70
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
4340
60
Hospital Rate Reductions DSH ReductionDSH Redesign
0
10
20
30
40
50
60
70
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
Page 33
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
30
Figure 32. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Adult, Aged Aid Categories
Figure 33. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Adult, Blind and Disabled Aid Categories
57
35
66
Hospital Rate
Reductions DSH
ReductionDSH
Redesign
0
10
20
30
40
50
60
70
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
136
114
161
Hospital Rate Reductions DSH ReductionDSH Redesign
0
20
40
60
80
100
120
140
160
180
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
Page 34
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
31
Figure 34. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Adult, Families and Children Aid Categories
Figure 35. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Metropolitan Counties
121
113
141
Hospital Rate
Reductions DSH
ReductionDSH
Redesign
0
20
40
60
80
100
120
140
160
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
73
57
85
Hospital Rate Reductions DSH ReductionDSH Redesign
0
10
20
30
40
50
60
70
80
90
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
Page 35
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
32
Figure 36. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Non‐Metropolitan Counties
S e a s o n a l ly A d j u s t e d I n p a t i en t H o s p i t a l U ti li za t i o n f o r A m b u l a t o r y Ca r e
Sen s i t ive Cond i t ions
Figures in this section show the trend in quarterly use of inpatient hospitals for ambulatory care
sensitive conditions (ACSC) by New Hampshire Medicaid beneficiaries as indicated by Medicaid claims
data.
Rates
of
hospitalization
for
an
ACSC
are
considered
to
be
a
measure
of
appropriate
primary
healthcare delivery. While not all admissions for these conditions are avoidable, appropriate
ambulatory care can help prevent, or control, acute episodes, and improve the management of these
illnesses or conditions. A disproportionately high rate of ACSC admissions may reflect underutilization
of appropriate primary care. The ambulatory care sensitive conditions included in this measure are:
asthma, dehydration, bacterial pneumonia, urinary tract infection, and gastroenteritis, which are
commonly grouped together as ACSC’s.
Data is only presented for the total Medicaid population due to the small number of cases that occur
each quarter, broken out by age and eligibility groupings, and broken out for metropolitan and non‐
metropolitan areas of the State.
The data has been adjusted to remove seasonality that in New Hampshire reliably results in higher than
average rates in the first calendar quarter and lower than average rates in the third calendar quarter
(due to seasonality of respiratory infections).
6764
85
Hospital Rate
Reductions DSH
ReductionDSH
Redesign
0
10
20
30
40
50
60
70
80
90
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate per 1,000 Mean Adjusted Rate Control Limit
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
33
For this measure, a rate above the control limits is the trigger indicating a potential access problem
requiring further investigation. Higher rates, especially in conjunction with lower use of primary care,
could indicate an access problem.
However, the rates shown in the figure do not cross the control limits, and therefore do not indicate a
potential access
problem.
Figure 37. Seasonally Adjusted Inpatient Hospital Utilization for Ambulatory Care Sensitive
Conditions per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Total Population
Season a l ly Ad j us t ed T o t a l Inp a t i en t H osp i t a l U t i li za t i on
Figures in this section show the trend in quarterly use of general inpatient hospitals by New Hampshire
Medicaid beneficiaries as indicated by Medicaid claims data.
Data is presented for the total Medicaid population, broken out by age and eligibility groupings, and
broken out for metropolitan and non‐metropolitan areas of the State.
The data presented has been adjusted to remove seasonality that in New Hampshire reliably results in
higher than average rates in the first calendar quarter and lower than average rates in the third calendar
quarter (due to seasonality of respiratory infections).
For the total inpatient hospital utilization measure, a rate either above or below the control limits is the
trigger indicating a potential access problem requiring further investigation. Higher rates, in conjunction
with lower use of primary care could indicate an access problem. Rates below the control limit could
indicate more appropriate use of care (a goal of the program), but would still be investigated if provider
enrollment data indicates the potential for reduced inpatient hospital access.
0.70
0.40
0.81
Hospital Rate Reductions DSH ReductionDSH Redesign
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Adjusted Rate
per
1,000 Mean
Adjusted
Rate Control
Limit
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
34
The rates shown in all figures never cross the control limits, and therefore do not indicate a potential
access problem.
Figure 38. Seasonally Adjusted Inpatient Hospital Utilization per 1,000 NH Medicaid Beneficiaries, CY
2007‐2011: Total Population
An n u al Ut il iza t ion o f Pr even t ive an d Of fi ce /Clin ic Hea l th Serv ices
Figures in this section show the trend in the percent of continuously enrolled New Hampshire Medicaid
beneficiaries who made use of at least one expected service as indicated by Medicaid claims data.
Measure definitions follow those specified by the National Committee on Quality Assurance (NCQA).
These measures are calculated using annual data because expected service use is based on an annual (or
greater) period. Only continuously enrolled beneficiaries (with no more than a one month gap in
coverage) are included to ensure adequate time for the expected service use to occur. Where available,
national NCQA averages for Medicaid are reported on the charts.
Measures presented include:
• Six or More Well‐Child Visits in the First 15 Months of Life,
• Well‐Child Visits in the Third Through Sixth Years of Life,
• Adolescent Well‐Care Visits,
• Child Access to Preventive/Ambulatory Health Services by Age, and
• Adult Access to Preventive/Ambulatory Health Services by Age.
10
9
12
Hospital Rate Reductions DSH ReductionDSH Redesign
0
2
4
6
8
10
12
14
2007
QTR 1
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
Rate per 1,000 Mean Rate Control Limit
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
35
Measures are presented for the total Medicaid population, broken out for metropolitan and non‐
metropolitan areas of the State, except for the Child and Adult Access to Preventive/Ambulatory Health
Services by Age measures.
For charts based on annual data, control limits are not presented (annual data does not provide enough
experience for
meaningful
limits).
Instead,
95%
confidence
intervals
are
presented.
The
confidence
interval takes into account random variability in the data to allow for comparison of rates over time.
The 95% confidence interval is the range of values that, with 95% certainty includes the underlying rate
for the entire population. As the number of beneficiaries represented in the rate increase, the
confidence intervals become narrower.
If the current period of data deviates to such a degree that its confidence interval does not overlap with
the prior period’s confidence interval it will indicate a potential access problem requiring further
investigation. Additionally, if a slowly changing trend is observed and the current period’s confidence
interval does not overlap with any of the previous three confidence intervals it will indicate a potential
access problem requiring further investigation.
Analysis of the trends and confidence intervals do not indicate a potential access problem.
Figure 39. Percent of Continuously Enrolled NH Medicaid Beneficiaries With Six or More Well‐Child
Visits in the First 15 Months of Life, CY 2007‐2011: Total Population
77.1%
71.9% 72.8% 73.4% 74.8% 74.4%
77.7% 78.6% 78.9% 80.2% 79.9%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CY 2007 CY 2008 CY 2009 CY 2010 CY 2011
2011 National Medicaid NCQA HEDIS Average = 60.2%
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
36
Figure 40. Percent of Continuously Enrolled NH Medicaid Beneficiaries With Six or More Well‐Child
Visits in the First 15 Months of Life, CY 2007‐2011: Metropolitan Counties
Figure 41. Percent of Continuously Enrolled NH Medicaid Beneficiaries With Six or More Well‐Child
Visits in the First 15 Months of Life, CY 2007‐2011: Non‐Metropolitan Counties
76.6%
68.9% 70.1% 70.9%73.4% 73.0%
76.6% 77.7% 78.3% 80.7% 80.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CY 2007 CY 2008 CY 2009 CY 2010 CY 2011
78.0%
73.2% 73.3% 74.4% 74.6% 73.8%
82.3% 82.5% 83.2% 83.1% 82.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CY 2007 CY 2008 CY 2009 CY 2010 CY 2011
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
37
Figure 42. Percent of Continuously Enrolled NH Medicaid Beneficiaries in the Third Through Sixth
Years of Life With a Well‐Child Visit, CY 2007‐2011: Total Population
Figure 43. Percent of Continuously Enrolled NH Medicaid Beneficiaries in the Third Through Sixth
Years of Life With a Well‐Child Visit, CY 2007‐2011: Metropolitan Counties
76.9%
71.7% 71.9%75.2% 75.4% 75.6%
74.7% 74.9%78.1% 78.1% 78.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CY 2007 CY 2008 CY 2009 CY 2010 CY 2011
2011 National Medicaid NCQA HEDIS Average = 71.9%
78.6%
72.4% 72.8%76.6% 76.8% 76.8%
76.6% 76.8%80.5% 80.5% 80.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CY 2007 CY 2008 CY 2009 CY 2010 CY 2011
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
38
Figure 44. Percent of Continuously Enrolled NH Medicaid Beneficiaries in the Third Through Sixth
Years of Life With a Well‐Child Visit, CY 2007‐2011: Non‐Metropolitan Counties
Figure 45. Percent of Continuously Enrolled Adolescent NH Medicaid Beneficiaries With a Well‐Care
Visit, CY 2007‐2011: Total Population
75.0%
69.1% 69.3%72.5% 72.4% 72.9%
73.8% 73.9%76.9% 76.6% 77.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CY 2007 CY 2008 CY 2009 CY 2010 CY 2011
50.8%
46.0% 46.6%50.2% 49.9% 49.8%
47.9% 48.6%52.2% 51.8% 51.7%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CY 2007 CY 2008 CY 2009 CY 2010 CY 2011
2011 National Medicaid NCQA HEDIS Average = 48.1%
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
39
Figure 46. Percent of Continuously Enrolled Adolescent NH Medicaid Beneficiaries With a Well‐Care
Visit, CY 2007‐2011: Metropolitan Counties
Figure 47. Percent of Continuously Enrolled Adolescent NH Medicaid Beneficiaries With a Well‐Care
Visit, CY 2007‐2011: Non‐Metropolitan Counties
52.1%
47.8% 48.2%
52.8% 52.1% 50.8%
50.4% 51.0%
55.6% 54.8% 53.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CY 2007 CY 2008 CY 2009 CY 2010 CY 2011
49.9%
45.2% 45.8%48.6% 48.0% 48.5%
48.0% 48.8%51.6% 50.9% 51.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
CY 2007 CY 2008 CY 2009 CY 2010 CY 2011
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
40
Figure 48. Percent of Continuously Enrolled NH Medicaid Child Beneficiaries With a Preventive or
Other Ambulatory Service, SFY 2007‐2011 by Age: 0 to 11 Months
Figure 49. Percent of Continuously Enrolled NH Medicaid Child Beneficiaries With a Preventive or
Other Ambulatory Service, SFY 2007‐2011 by Age: 12 to 24 Months
97.4%
97.6% 97.2% 97.8% 96.9% 96.3%
99.4% 99.2% 99.5% 98.9% 98.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
SFY 2007 SFY 2008 SFY 2009 SFY 2010 SFY 2011
96.6%
97.1% 97.0% 97.5% 96.9% 96.1%
98.1% 98.0% 98.4% 97.8% 97.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
SFY 2007 SFY 2008 SFY 2009 SFY 2010 SFY 2011
2011 National Medicaid NCQA HEDIS Average = 96.1%
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
41
Figure 50. Percent of Continuously Enrolled NH Medicaid Child Beneficiaries With a Preventive or
Other Ambulatory Service, SFY 2007‐2011 by Age: 25 Months to 6 Years
Figure 51. Percent of Continuously Enrolled NH Medicaid Child Beneficiaries With a Preventive or
Other Ambulatory Service, SFY 2007‐2011 by Age: 7 to 11 Years
89.8%
88.4% 88.4% 89.5% 90.3% 89.4%
89.4% 89.4% 90.4% 91.2% 90.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
SFY 2007 SFY 2008 SFY 2009 SFY 2010 SFY 2011
2011 National Medicaid NCQA HEDIS Average = 88.3%
87.5%
86.0% 85.2% 86.6% 87.6% 87.0%
87.2% 86.5% 87.8% 88.7% 88.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
SFY 2007 SFY 2008 SFY 2009 SFY 2010 SFY 2011
2011 National Medicaid NCQA HEDIS Average = 90.2%
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
43
Figure 54. Percent of Continuously Enrolled NH Medicaid Adult Beneficiaries With a Preventive or
Other Ambulatory Service, SFY 2007‐2011 by Age: 45 to 64 Years
Bene f ic ia r y Ass i s t an ce an d Sa t i s fac t ion
Benef ic ia r y Requ es t s f o r As s is t an ce Acces s in g P r ov ide r s
As
detailed
further
in
the
Beneficiary
Engagement
chapter
of
this
report,
New
Hampshire
Medicaid
maintains a Client Services unit with a toll free number that responds to beneficiary requests for
assistance in finding providers. Client Services systematically tracks information about these requests in
a database. An increasing trend in requests for assistance finding a provider could be an indication that
there is an emerging access problem triggering the need for further research. Client Services also often
receives information from beneficiaries regarding the reason they need help finding a provider. While
this information is anecdotal, it too may lead to further research.
The information from Client Services is available on a timelier basis than utilization data that requires a
lag period to allow for claims to be submitted and processed. In this report, and in future reporting,
Client Services data will be one quarter more current than information based on claims data. Because of
this, Client Services information provides the best early warning indicator of potential access problem.
The figure below shows the trend in beneficiary requests for assistance finding a provider. Major New
Hampshire Medicaid payment changes are indicated and control limits at the third standard deviation of
the historical data are included to provide a trigger indicating a potential access problem requiring
further investigation. The overall trend is presented, followed by detail on the trends by metropolitan
and non‐metropolitan areas of the State.
93%
89% 90% 90% 89% 90%
96% 96% 96% 95% 95%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CY 2006 CY 2007 CY 2008 CY 2009 CY 2010
2011 National Medicaid NCQA HEDIS Average = 86.1%
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
44
For overall call data and data from members living in metropolitan counties at no point during the time
period does the control chart indicate a potential access issue requiring further research. However, the
data for non‐metropolitan counties in the fourth quarter of CY 2011 did cross the control limit, which
resulted in further research and action.
Research determined
that
the
spike
in
calls
asking
for
provider
assistance
was
because
of
the
Lakes
Region General Hospital's decision to close some of their practices to adult Medicaid beneficiaries. In
late October, 2011, Client Services had 32 calls from adult Medicaid beneficiaries in the Lakes Region
needing new primary care physicians. After Client Services performed telephone outreach to the same
population, we had an additional 79 calls to find or discuss providers in the Lakes Region. The above
calls, totaling 111, were 35% of the calls from non‐metropolitan areas requiring assistance with
providers.
Since that time, after the assistance was provided, these types of calls have returned to the normal
volume.
Figure 55. Beneficiary Requests for Assistance Accessing Providers per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2012: Total Population
2.2
1.2
3.1
Hospital Rate Reductions DSH ReductionDSH Redesign
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
2007
QTR 2
2007
QTR 3
2007
QTR 4
2008
QTR 1
2008
QTR 2
2008
QTR 3
2008
QTR 4
2009
QTR 1
2009
QTR 2
2009
QTR 3
2009
QTR 4
2010
QTR 1
2010
QTR 2
2010
QTR 3
2010
QTR 4
2011
QTR 1
2011
QTR 2
2011
QTR 3
2011
QTR 4
2012
QTR 1
Rate per 1,000 Mean Rate Control Limit
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
46
Ben ef ic ia r y Sat i s fac t ion Su r vey
New Hampshire Medicaid has recently contracted with a vendor to administer and report the results
from the core Adult and Child versions of the Agency for Healthcare Research and Quality’s (AHRQ)
Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for Medicaid populations.
The survey will be administered in July 2012 with data to be presented in a future update to this report,
along with
national
benchmarks,
on
the
following
measures:
• Rating of Doctors ‐ Children
• Rating of Doctors ‐ Adults
• Getting Needed Care ‐ Children
• Getting Needed Care ‐ Adults
• Getting Care Quickly ‐ Children
• Getting Care Quickly ‐ Adults
Conc lus ionAt this time, all measures are within normal limits, with no detectable negative trends. This report
includes 56 measures of beneficiary enrollment trends, provider availability, utilization of hospital and
primary care services, and beneficiary engagement trends over the most recent five‐year period. With
the exception of one data point, all measures are within normal limits. One data point in Figure 57,
Beneficiary Request for Assistance, in the fourth quarter of 2011 exceeds the control limit. This
situation was related to Lakes Region General Healthcare redirecting its adult patients to other local
practices. Corrective action was taken as described in the introduction to that measure. As a result, call
volume returned to a normal level in the following quarter, indicating resolution of the LRGH event.
In some
cases,
trends
are
improving.
The
ratio
of
beneficiaries
to
active
in
‐state
primary
care
providers
in Figure 10 indicates that an increasing number of providers are offering primary care services to
Medicaid beneficiaries. Emergency room utilization for conditions potentially treatable in a primary
care setting in Figure 22 through Figure 27 is improving, most notably in Figure 24, blind and disabled
adult categories, Figure 25, adults in the children and family aid categories, and Figure 27, the non‐
metropolitan areas. The trends in total emergency room use in Figure 28 through Figure 36 are also
improving in some categories, most notably in Figure 31, foster children, and Figure 36, non‐
metropolitan areas. Nine of the eleven well child measures in Figures 42 through 48 show upward
improvements over the past five years, with the remaining two measures above national average.
Figure 13 through Figure 21, Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000, indicate a
spike in utilization during the 2009 time period and a steady leveling off since that time. The spike
relates to the H1N1 pandemic that occurred then, with the leveling off of utilization demonstrating a
return to non‐pandemic levels of utilization. At all times, the data points did not exceed the control
limits.
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MONITORING ACCESS TO CARE IN NEW HAMPSHIRE’S MEDICAID PROGRAM: REVIEW OF KEY INDICATORS, JUNE 2012
New Hampshire Department of Health and Human Services
Office of
Medicaid
Business
and
Policy
48
The Medicaid Client Services Unit’s weekly report is produced every Monday for the previous week. The
key components of this report are the number of beneficiary call logs started and completed, the
number of incoming beneficiary calls taken live or sent to voicemail, and the number of beneficiary from
clients seeking assistance finding a provider.
There is
a separate
log
for
each
call,
detailing
the
issues
presented,
discussed,
and
resolved.
Client
Services strives to respond to all calls as they come in. For those beneficiary calls that go to voicemail,
staff returns more than 98% of the calls the same day.
Beneficiary calls to the Client Services Unit asking for assistance to locate a provider are tracked by
requested provider type. The number of calls is given, as well as the total number of Medicaid
beneficiaries requesting providers. For example, one caller may ask for the name of a dentist for her 4
children. This request is logged in as one call and four beneficiaries.
From the period of 2007 – 2011, New Hampshire Medicaid has seen no significant spikes in beneficiary
calls requesting assistance finding providers who accept Medicaid, with the exception of the time period
when one
of
the
state’s
hospital
systems,
Lakes
Region
General
Hospital
(LRGH),
notified
beneficiaries
in
November 2011 that it would be closing its physician practices to some Medicaid beneficiaries.
Medicaid beneficiaries were the first to alert New Hampshire Medicaid of this closure notification and
potential disruption in beneficiaries’ access to care. Client Services Unit staff immediately informed the
Medicaid Director, Medicaid Finance Director, and other Medicaid staff of the LRGH action. A corrective
action plan was immediately developed and implemented. The Client Services Unit helped each
beneficiary who needed help finding alternative providers. Engaging with beneficiaries through their
phone calls and reviewing the beneficiary call center report helps New Hampshire Medicaid monitors
access to care.
When a beneficiary
calls
New
Hampshire
Medicaid
requesting
assistance
finding
a provider,
the
Client
Services Unit locates providers, through a search of its provider database by provider type, within a 25‐
mile radius of the beneficiary’s home. Client Services provides the list of appropriate providers to the
beneficiary over the phone, by postal mail, email, or fax, according to each beneficiary’s preference.
The provider list includes providers’ names, street addresses, and phone numbers.
New Hampshire Medicaid, through its Client Services Unit, has found alternative providers for every
beneficiary told by their providers that they no longer accept Medicaid. Client Services maintains a
database of providers who accept new Medicaid patients, by regularly calling providers’ offices for
updated information. All difficulties presented by beneficiaries concerning healthcare access issues
have
been
successfully
addressed
and
resolved
by
the
Medicaid
Client
Services
Unit.
New Hampshire Medicaid also engages beneficiaries and potential beneficiaries by providing brochures
and other informational materials to approximately 1,900 locations statewide, including schools,
hospitals, town/city welfare offices, courthouses, legal assistance programs and unemployment offices.
Additional distribution points include childcare providers, soup kitchens/food pantries, homeless
shelters, and health care providers (ob‐gyn, pediatric and primary care). Targeted outreach is currently
being conducted for adolescents, culturally/racially diverse groups, and the recently unemployed. New
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Hampshire Medicaid also helps families access health care coverage at the community level through its
Application Assistors program. Application assistors are stationed at nineteen hospitals, eleven
Federally Qualified Health Centers (FQHC) and community health centers, and other primary care
provider and referral organization sites.
Med ica l Car e Adv iso r y Com m i t t ee (MCAC)
New Hampshire Medicaid created the New Hampshire Medical Advisory Committee (MCAC), well over
twenty years ago, to advise the Medicaid director about New Hampshire Medicaid health policy,
planning, and medical care services. The primary purpose of New Hampshire’s MCAC is to serve as a
source of consumer and stakeholder involvement in the Medicaid program. The MCAC has also had an
advisory role in the design and implementation of Medicaid Managed Care in New Hampshire. New
Hampshire’s MCAC meets on a monthly basis and, among other things, reviews and recommends
Medicaid policy and planning proposals; discusses various Medicaid provider and beneficiary issues; and
ensures communication between MCAC members and the New Hampshire Medicaid leadership. It has
been and
will
continue
to
be
used
to
provide
a forum
for
reviewing
data
and
analysis
that
addresses
issues related to Medicaid beneficiary access to care in New Hampshire and for planning Step Two of the
transition to managed care.
The New Hampshire MCAC has 21 members, comprised of Medicaid beneficiaries [5],
beneficiary/consumer advocacy groups members of the general public concerned about health service
delivery to Medicaid Beneficiaries [4]; healthcare professionals who serve Medicaid beneficiaries [8],
and other knowledgeable individuals with experience in healthcare, rural health, Medicaid law and
policy, healthcare financing, quality assurance, patient's rights, health planning, pharmacy care [4], and
those familiar with the healthcare needs of low‐income population groups and the Medicaid population.
These meetings are open to the public, and routinely, three representatives of the general public are in
attendance. In addition, DHHS program staff members from all aspects of the New Hampshire Medicaid
program are in attendance.
St a k e h o l d e r M e e t in g s
As a part of the process of determining and/or implementing major policy change at the Department of
Health and Human Services, a stakeholder engagement process is used whereby community forums are
held throughout the State to provide information to and solicit input from community partners,
providers, institutions, and beneficiaries. The purpose of stakeholder meetings are to: 1. Begin the
process of sustained dialogue leading to shared understanding; 2. Set principles and strategies to guide
transformation; and 3. Outline the approach for moving forward.
Stakeholder meetings have occurred multiple times on a variety of subjects over the past several years.
Most relevant to this reporting are the following: In 2008, stakeholders were brought together to
engage in a Healthcare transformation project designed to examine business processes to streamline
and drive out non‐value added activities that contribute to costs that could better be directed to the
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care of clients. The stakeholder council meetings were organized into three subject matter groups of
public health/medical services, human services, and long term care services. Ultimately, the discussions
led to the "Front Door" project, which streamlines how clients enter and access services in New
Hampshire.
In 2009
and
into
2010,
chief
executive
and
finance
officers
from
New
Hampshire’s
26
acute
care
hospitals and two rehabilitation hospitals were brought together in a series of meetings to explore
alternative payment methods in the Disproportionate Share Program which ultimately resulted in a
revised distribution methodology of available DSH dollars proportional to the amount of
uncompensated care provided by hospitals.
Currently, The New Hampshire Department of Health and Human Services is holding eleven information
sessions throughout the State on the new Medicaid Care Management program. The meetings are for
those who use Medicaid services as well as family members and caregivers and for human service
agency case managers or service coordinators who work with them. Information covered is on the first
step of the new Medicaid Care Management program scheduled to launch later this year. The first step
encompasses those Medicaid services that address medical needs, such as doctor visits, inpatient and
outpatient hospital visits, prescriptions, mental health services, home health services, speech therapy,
and audiology services.
In summary,
• New Hampshire Medicaid regularly engages with Medicaid beneficiaries directly and
indirectly, via beneficiary advocates and Medicaid providers, through its participation in the
Medical Care Advisory Committee. The MCAC meets on a monthly basis.
• In addition to MCAC meetings, DHHS holds stakeholder meetings from time to time when
considering or
implementing
major
policy
changes.
• New Hampshire Medicaid regularly engages with Medicaid beneficiaries who call the hotline
managed by the Medicaid Client Services Unit. The Unit entertains about 800 calls per week
to and from beneficiaries posing a variety of questions ranging from benefit verifications to
assistance finding transportation or a doctor.
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5. Plan for Monitoring Access
U p d a t e s t o M o n it o r i n gAs part of its access monitoring strategy, New Hampshire Medicaid will conduct these periodic reviews
of access compliance. Data analysis and reporting will be conducted quarterly and within forty‐five days
after the close of the quarter. New Hampshire Medicaid will continue to review and revise the
Monitoring Plan itself to ensure the continued relevance of the selected indicators, and to expand it
over time to include other Medicaid benefits, including behavioral health, long‐term care services, and
managed care.
In ves t iga t ion o f Access I s su es an d Cor r ec t ive Ac t ion s
New Hampshire
Medicaid
has
a two
‐tier
detection
system
in
place.
The
first
detection
method
is
based
on the systematic, ongoing monitoring as displayed in this report. The second method is the real‐time
and individualized detection and resolution that occurs by the Medicaid Client Services Unit.
Should a systemic access issue be detected through New Hampshire’s quarterly access monitoring
report, New Hampshire Medicaid would activate a Corrective Action Response Team to research the
specific cause(s) of the problem and make recommendations for corrective action to the State Medicaid
Director and the Department’s Medicaid Executive Team within 45 days of discovering the problem.
The multidisciplinary response team shall consist of a member of each of the following units: the
Medicaid Client Services Unit, the Financial Management and Reimbursement Unit, the Benefits
Management Unit,
the
Provider
Network
Management
Unit,
and
the
Health
Data
and
Analytics
Unit.
Its
role would be to communicate with beneficiaries and providers, as necessary, to assess additional data
to determine the cause of the access issue, propose corrective actions, and develop additional
monitoring systems as necessary to monitor progress toward access compliance. The existing MCAC will
also provide a readily available resource to engage stakeholders in this process. The timing and nature
of any corrective actions taken will necessarily depend upon the particular nature and magnitude of the
access problem identified and the beneficiary population affected.
Corrective actions shall set a target for compliance with access requirements as soon as possible, but no
later than within one year of the corrective action plan approval, depending on the complexity and
magnitude of
the
problem.
Possible
corrective
actions
include
but
are
not
limited
to:
• Resolving provider administrative burdens, such as claims submission and payment issues;
• Assisting beneficiaries in obtaining necessary primary or specialty care services through provider
referral, transportation assistance, or enrollment in Medicaid Managed Care;
• Assessing and realigning covered benefits so that additional resources can be directed toward a
resource‐challenged area.
• Incentivizing the expansion of healthcare providers in underserved areas in the State.
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• Restructuring rates and targeting them to address the particular underserved areas.
Surveillance by the Medicaid Clients Services Unit is a second method of detecting any issues to access
of care and providing problem resolution/corrective action on a real time, case‐by case basis. New
Hampshire
has
long
had
in
place
an
800‐
telephone
number
that
beneficiaries
can
call
for
assistance.
The phone number appears on the Medicaid member card, in the Member welcome packet, and in all
beneficiary communications and outreach materials. The Medicaid Client Services Unit manages a call
center, providing ombudsman services to clients who need assistance, maintaining an up‐to‐date
network reference guide, and offering referrals to providers upon request, and providing transportation
assistance and transportation reimbursement. In addition to case‐by‐case problem resolution, the
Medical Client Services unit maintains call logs and is alert for any accumulation of similar complaints
that indicate a trend.
Should an acute access issue be detected (as in the case of LRGH), the State Medicaid Director will be
notified immediately. The Medicaid Director will be responsible for alerting the Department's Executive
Team and the CMS Regional Office. The Medicaid Director will activate a Corrective Action Response
Team to research the specific causes including gathering facts directly from those providers implicated
in the access issue, analyze to project potential client impact, confirm real time available alternative
provider availability, and augment staffing to the Client Services Unit to include additional staff and
extended hours of operations. Specific messaging to Medicaid beneficiaries potentially impacted will be
issued via media outlets, community network partners, and social media including Facebook and
Twitter. These response strategies will be implemented on the same day that New Hampshire Medicaid
becomes aware of a potential acute access issue. For the first 3 days post an acute event, the Medicaid
Director will conduct a conference call update with the Corrective Action Response Team members at
8:00 a.m. each day. In addition the Medicaid Director will provide status reports via email by 12:00
Noon and 4:30 p.m. each day. As the time goes on, the reporting schedule will be modified as
appropriate. A written synopsis of the acute access issue and the New Hampshire Medicaid program's
response will be made available to CMS and the general public 30 days after the Medicaid Director has
deemed the acute incident to be resolved and included in the next published access monitoring report.
Ac ce s s M o n it o r i n g u n d e r M e d i ca i d M a n a g e d Ca r e
In 2011, the New Hampshire Legislature directed the Commissioner of the Department of Health and
Human Services (DHHS) to develop a comprehensive, statewide managed care program for all Medicaid
beneficiaries. Upon CMS approval and successful readiness reviews, DHHS will begin enrolling Medicaid
beneficiaries into one of three Managed Care Organizations (MCOs) by October 1, 2012. It is anticipated
that by December 1, 2012, New Hampshire Medicaid expects to have transitioned most of its Medicaid
and CHIP beneficiaries into a managed care program. Managed Care contractors are currently
developing their networks in response to the State's desire for adequate access within the managed
care program, and are required to demonstrate compliance prior to being approved to proceed with
enrollment. The MCOs will provide a comprehensive risk‐based, capitated program for providing
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healthcare services to beneficiaries enrolled in the New Hampshire Medicaid Program and provide for
all aspects of managing such program.
With this new Care Management program, DHHS has the opportunity to develop a comprehensive New
Hampshire Medicaid Quality Strategy, building on New Hampshire legislative goals of value, quality
assurance, and
efficiency,
and
focused
on
the
health
of
Medicaid
beneficiaries.
DHHS’
Quality
Strategy,
currently in the review and approval process, will serve to assure stakeholders that New Hampshire’s
managed care organizations (MCOs) are in contract compliance, have committed adequate resources to
perform internal monitoring and ongoing quality improvement, and actively contribute to healthcare
improvement for the State’s most vulnerable citizens. New Hampshire is creating a comprehensive
outreach and education plan to assure diverse methods of engaging clients. All New Hampshire
Medicaid beneficiaries will be encouraged to enroll in managed care and will be given the opportunity to
choose the managed care plan that best suits their needs. The Quality Strategy articulates the MCO
reporting that will provide data driven analysis to New Hampshire Medicaid and CMS of MCO provider‐
network adequacy. In addition, New Hampshire’s External Quality Review Organization (EQRO), which
will be
procured
in
the
Fall
of
2012,
through
validation
of
MCO
data
and
reporting,
will
serve
as
an
additional level of provider network adequacy and access oversight.
Beginning in December 2012, access issues will be addressed by the MCOs in the first instance. New
Hampshire Medicaid will monitor compliance with each MCO’s contractual responsibilities, including,
responsibilities for assuring access and quality, and will continue to assure access to care for New
Hampshire Medicaid beneficiaries.
To help ensure appropriate access to healthcare services for Medicaid beneficiaries in its managed care
program and pursuant to DHHS’ Care Management Contract with the MCOs, the MCOs are required,
inter alia, to:
• implement procedures that ensure that Medicaid beneficiaries have access to an ongoing
source of primary care appropriate to their individual needs;
• provide non‐emergent medical transportation to ensure Medicaid beneficiaries receive
medically necessary services and ensure that a beneficiary’s lack of transportation is not a
barrier to accessing care;
• maintain a Member Services Department to assist Medicaid beneficiaries and their family
members obtain services under the Care Management Program;
• operate a New Hampshire specific call center to handle member inquiries;
• develop and facilitate a Medicaid member advisory board composed of members who
represent an
MCO’s
member
population;
• hold bi‐annual, in‐person regional member meetings to obtain feedback and take questions
from members;
• conduct a member satisfaction survey (CAHPS) to gain a broader perspective of member
opinions;
• ensure that services are provided in a culturally competent manner to all Medicaid
members, including those with limited English proficiency;
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• develop appropriate methods of communicating and working with its members who do not
speak English as a first language, as well as members who are visually and hearing impaired,
and accommodating members with physical and cognitive disabilities and different literacy
levels, learning styles, and capabilities;
• develop, implement, and maintain a Grievance System under which Medicaid members, or
providers acting
on
their
behalf,
may
challenge
the
denial
of
coverage
or
payment
for
medical assistance and which includes a grievance process, an appeal process, and access to
the State’s fair hearing system; and
• publish a Provider Directory that shall be approved by DHHS.
In addition to the member‐focused provisions in the managed care contracts, DHHS will require
each MCO to ensure provider availability for its Medicaid beneficiaries and to:
• have provider networks with a sufficient number of providers with sufficient capacity,
expertise and geographic distribution, to provide for all Medicaid‐covered services, and with
reasonable choice
for
beneficiaries
to
meet
their
needs;
• submit to annual, external, independent review of the timeliness of and access to services
covered under each MCO contract with DHHS;
• develop and maintain a statewide provider network that adequately meets the physical and
behavioral health needs of enrolled Medicaid beneficiaries;
• report significant changes to the provider network to DHHS, with a transition plan to
address member access to needed services, within seven days of any significant change;
• develop an active provider advisory board composed of a broad spectrum of provider types;
• develop a provider satisfaction survey, which is required to be approved by DHHS and
administered by third party semi‐annually;
• provide the results of the provider satisfaction survey to DHHS and post on the MCOs’
website;
• meet contractual geographic access standards for all Medicaid beneficiaries in additions to
maintaining a provider network sufficient to provide all services to all of its Medicaid
members;
• make services available for beneficiaries twenty‐four hours a day, seven days a week, when
medically necessary; and
• develop and maintain a statewide provider network that adequately meets all covered
physical and behavioral health needs of the covered population that provides for
coordination and collaboration among providers and disciplines. See full text of Access and
Network Management managed care contract provisions attached as Appendix B.
New Hampshire Medicaid will manage and monitor MCO performance and compliance with all
contract provisions, including those addressing access, provider availability and delivery of quality
care. With a primary goal of quality care, New Hampshire Medicaid requires the MCOs to:
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• provide for the delivery of quality care to improve the health status of beneficiaries, or if a
beneficiary’s health condition is such that it cannot be improved then to maintain the
beneficiary’s health;
• comply with the Quality Strategy for the New Hampshire Medicaid Care Management
Program;
• have an
ongoing
quality
assessment
and
performance
improvement
program
for
the
services it provides beneficiaries;
• approach all clinical and non‐clinical aspects of quality assessment and performance
improvement based on Continuous Quality Improvement (CQI)/Total Quality Management
(TQM);
• have mechanisms in place that detect both under‐ and over‐utilization of services;
• develop and operate a Quality Assessment and Performance Improvement (QAPI) Program
and to submit a QAPI Program Annual Summary as specified by DHHS;
• maintain a QAPI structure that includes a planned systematic approach to improving clinical
and non‐clinical processes and outcomes;
• adopt evidence‐based clinical practice guidelines built upon high quality data and strong
evidence considering the needs of Medicaid beneficiaries;
• collaborate with DHHS’s External Quality Review Organization (EQRO) to develop studies,
surveys, and other analytic activities to assess the quality of care and services provided to
beneficiaries, and shall supply data to the EQRO.
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6. Summary and Conclusion
Ensuring
access
to
care
is
a
priority
of
the
New
Hampshire
Medicaid
program.
The
foregoing
report
provides specific data and analysis that establish historical and current access levels for physician
services, inpatient and outpatient services, rate structures, and the impact of DSH payments, all of
which establish the following:
• The data showing historical and current access levels for physician services, inpatient and
outpatient services, set forth in report Chapter 3, are within normal limits, with no
detectable negative trends.
• The data showing the historical access to care based on participating provider network size
and capacity, service utilization trends, and rate levels, set forth in report Chapter 3, are
within normal limits, with no detectable negative trends.
• The trend analysis on data elements demonstrate that rate changes which occurred in 2008
and Disproportionate Share Program changes (described in Chapter 2) have not changed
access levels.
• New Hampshire Medicaid presented evidence, set forth in Chapter 5 of the report, that
indicates that it has regular, ongoing engagement with Medicaid beneficiaries in order to
assess the unique characteristics and needs of beneficiaries, to monitor access to healthcare
and other issues of concern to beneficiaries and to intervene on the behalf of any
beneficiary requesting assistance with provider availability and access, or with any other
issue creating a barrier to access.
• Provider access monitoring plans and procedures, set forth in Chapter 5, indicate that New
Hampshire is well positioned to systematically monitor beneficiary needs, the strength and
availability of the provider network, and beneficiary utilization of healthcare services.
• New Hampshire Medicaid’s systematic monitoring of access indicators help identify access
problems for beneficiaries. Should access issues arise, New Hampshire Medicaid will take
corrective actions, as set forth in Chapter 5, to resolve access issues for New Hampshire
Medicaid beneficiaries.
In conclusion, New Hampshire Medicaid the data indicates that Medicaid beneficiaries have similar
access to healthcare as the general population in New Hampshire. All data collected and analyzed falls
within control chart parameters. All data collected and analyzed falls within control chart parameters.
Nothing has
been
detected
in
those
control
charts
that
would
indicate
a negative
healthcare
access
trend. To the extent potential provider‐access issues have been identified at any point during the time
period examined, i.e. 2007‐2011, New Hampshire Medicaid has intervened and resolved them.
New Hampshire Medicaid routinely monitors access indicators, i.e. beneficiary enrollment and
demographics, provider enrollment and availability, and beneficiary utilization of health care services
and will produce a quarterly data report similar to the report set forth above to measure and monitor
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beneficiary access to healthcare in New Hampshire. With the ability to identify access issues as they
arise comes the concomitant ability of New Hampshire Medicaid to respond effectively to correct those
issues. Although the data indicate no existing or projected access problems, should an access issue be
identified through these monitoring systems, DHHS is ready to take corrective action measures on both
a localized and system‐wide basis through the processes set forth in this report.
By increasing New Hampshire Medicaid’s monitoring of the strength of provider network activity;
surveying network capacity; conducting client surveys to assess their experiences with providers and
their needs relative to access; increasing outreach to providers and beneficiaries; and transforming the
New Hampshire Medicaid program from a fee‐for‐service plan to a managed care approach, New
Hampshire will continue to ensure access for its Medicaid beneficiaries.
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7. Appendices
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Ap p e n d i x A: N e w H a m p s h i r e M e d i ca i d Co m m u n it y H e a lt h
Cen te r Access an d Capac i ty
Data was collected in May 2012 with the assistance of Bi‐State Primary Care Association.
Facility
Current
Medicaid Patient
Count
Capacity for
additional patients
Wait time for routine
appointments
Wait time for urgent
appointments Notes
Lamprey Newmarket 847 250 10 days
Same day or within 24
hours: Sick or acute
patients
Could add provider
capacity and take
1,300 in existing
space
Lamprey Raymond 932 300 15 days
Same day or within 24
hours: Sick or acute
patients
Additional staff ‐
Could accommodate
another 800
Family Health Center
(Concord Hospital) 3,708 10 per week
Same day to within 90
days ‐ complete
physical for all patients
Within 2 weeks: OB
intake appt Same day
Family Health Center
(Hillsborough) 686 1 per week
Same day to within 90
days‐
complete
physical for all patients
Within 2 weeks: OB
intake appt Same day
Manchester Community
Health Center 3,553 500
New : Prenatal ‐ 1‐2
days
Pediatrics 1‐2 weeks
Adults 6‐8 weeks
Established: Routine 1
week
Physical Exams 4‐
6weeks
Walk ins: Not available
Urgent care:1‐2 days
based on the urgency;
if the situation warrants
it, urgent needs are
triaged to local ER
1,500 Pediatric
patients currently
enrolled in NHHK will
transition from
Dartmouth to MCHC.
Will probably have
room for another 500
Medicaid patients
given current
provider capacity
Harbor Care
Clinic
Harbor
Homes ‐ Nashua 88
Open availability
for additional
clients Same day Immediate
Families First in Portsmouth 1,500
100 patients/300
in Oct. w/new
physician
Same day: Children
and adults
2 mornings a week:
Pregnant women seen
for routine visits
2 mornings a week:
Walk‐ in's
Same day slots: Every
day for anyone who
calls in the morning
White Mountain CHC in
Conway 1,334 134 2 weeks Same day
Mid‐state Health Center ‐
Plymouth 900
Significant or good
capacity to see
more patients
Same day or a few
days.
Some clinicians could
be a month Same day or next day
Coos County Family Health
Services 1,742 1,000
Child.&preg.women:
Same day
Adults: 0‐7 days
Urgent: Same day; 4 hrs
a week July:
Every afternoon
opened for
same
day
and for walk‐ ins (with a
Family Nurse
Practitioner that has
just been hired)
Right now, 4 hours/wk
of open slots for walk‐
ins/same days.
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Facility
Current
Medicaid
Patient
Count
Capacity for
additional patients
Wait time for routine
appointments
Wait time for urgent
appointments Notes
Ammonoosuc Comm. Health
Srvs ‐ Littleton
924 <
age 19;
393 >
age 20
Depending on the
site, the access is
variable, however
when sent there,
will work towards
accommodating.
Same day visit per
need basis:ACHS &
non‐ACHS patients.
Medical records need
to be
received
&
reviewed prior to
establishing the
patient as a health
home patient. Each
provider however
based on a panel size
may have variable
capacity to accept
more patients.
Same day/maybe at
alternative site
Health First in Franklin 1,391 600
3 wks: Routine follow
up & non acute appt
4
wks:
Full
entry
visits
new patients
5 wks: Full physicals
Same day or next day.
During peak days, Mon.
&
Fri.
may
be
two
days.
New NP on staff for
acute patients.
499 out of 1,391 new
clients that came
after LRGH stopped
seeing Medicaid
adults in regular
outpatient
practices
and had 302 new
uninsured clients
Goodwin Community Health
in Somersworth 3,099 2,500 3‐5 days Same day
Slots kept open daily
for acutes and will be
starting walk‐in times
Lamprey Health Care Nashua 2,628
2,000 and could
add provider
capacity to take
3,000 more if
necessary
Within 48 hours: new
mother/child
10 days: Adults, non‐
urgent enroll visit or
reguEFlar check‐up
Within 24 hours: acute
visit Same
day: When possible
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Ap p e n d i x B : Ta b u la r Ve r s i o n o f Da t a in T re n d Ch a r t s
Figure 4. NH Medicaid Enrollment, CY 2007‐2011: Total Population
Time Period Average Members
2007 QTR 1 82,880
2007 QTR 2 83,462
2007 QTR 3 83,444
2007 QTR 4 83,391
2008 QTR 1 84,380
2008 QTR 2 85,632
2008 QTR 3 86,783
2008 QTR 4 88,024
2009 QTR 1 90,866
2009 QTR 2 94,059
2009 QTR 3 96,178
2009 QTR 4 97,444
2010 QTR 1 98,287
2010 QTR 2 99,162
2010 QTR 3 99,813
2010 QTR 4 99,974
2011 QTR 1 100,362
2011 QTR
2
100,922 2011 QTR 3 100,952
2011 QTR 4 100,675
Figure 5. NH Medicaid Enrollment, CY 2007‐2011: Child, Families and Children Eligibility Group
and
Figure 6. NH Medicaid Enrollment, CY 2007‐2011: Child Foster Care and Blind and Disabled
Population
Time Period Blind and Disabled Families and Children Foster Care
2007 QTR 1 522 60,041 1,935
2007 QTR 2 526 60,522 1,981
2007
QTR
3
515
60,448 1,9442007 QTR 4 525 60,383 1,940
2008 QTR 1 536 60,962 1,953
2008 QTR 2 564 61,879 1,966
2008 QTR 3 580 62,672 1,908
2008 QTR 4 599 63,478 1,890
2009 QTR 1 604 65,423 1,867
2009 QTR 2 618 67,856 1,878
2009 QTR 3 619 69,560 1,805
2009 QTR 4 628 70,597 1,814
2010 QTR 1 605 71,192 1,793
2010 QTR 2 596 71,756 1,781
2010 QTR 3 597 72,260 1,717
2010 QTR 4 613 72,450 1,739
2011 QTR 1 598 72,788 1,720
2011 QTR 2 611 73,199 1,745
2011 QTR
3
597
73,450 1,6632011 QTR 4 606 73,447 1,668
Figure 7. NH Medicaid Enrollment, CY 2007‐2011: Adult Population by Eligibility Group
Time Period Aged Blind and Disabled Families and Children
2007 QTR 1 672 7,080 12,630
2007 QTR 2 668 7,238 12,528
2007 QTR 3 681 7,351 12,506
2007 QTR 4 690 7,486 12,367
2008 QTR 1 713 7,682 12,535
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Time Period Aged Blind and Disabled Families and Children
2008 QTR 2 711 7,894 12,618
2008 QTR 3 723 8,102 12,798
2008 QTR 4 746 8,354 12,956
2009 QTR 1 760 8,653 13,559
2009 QTR 2 767 8,898 14,043
2009 QTR 3 776 9,116 14,301
2009 QTR 4 779 9,157 14,469
2010 QTR
1
792
9,287
14,6192010 QTR 2 802 9,400 14,827
2010 QTR 3 815 9,488 14,934
2010 QTR 4 826 9,576 14,768
2011 QTR 1 848 9,702 14,705
2011 QTR 2 849 9,872 14,646
2011 QTR 3 884 9,945 14,411
2011 QTR 4 902 9,953 14,098
Figure 8. NH Medicaid Enrollment, CY 2007‐2011: Metropolitan and Non‐Metropolitan Counties
Time Period Metro Counties Non‐Metro Counties
2007 QTR 1 45,220 35,115
2007 QTR 2 45,484 35,459
2007 QTR 3 45,606 35,297
2007 QTR
4
45,716
35,2142008 QTR 1 46,166 35,661
2008 QTR 2 46,796 36,284
2008 QTR 3 47,454 36,687
2008 QTR 4 48,272 37,090
2009 QTR 1 49,874 38,250
2009 QTR 2 51,925 39,364
2009 QTR 3 53,131 40,115
2009 QTR 4 53,878 40,489
2010 QTR 1 54,421 40,864
2010 QTR 2 54,926 41,228
2010 QTR 3 55,541 41,423
2010 QTR 4 55,813 41,606
2011 QTR 1 56,115 41,917
2011 QTR 2 56,510 42,366
2011 QTR 3 56,626 42,541
2011 QTR
4
56,778
42,687
Figure 9. Active NH Medicaid In‐State Physician Providers Compared to Licensed Providers With NH
Billing Address, 2012
Active Medicaid Providers Active Non‐Medicaid Providers
3,793 254
Figure 10. Ratio of NH Medicaid Beneficiaries to Active In‐State Primary Care Providers (Internal
Medicine, Family Practice, General Practice, Pediatricians), CY 2007‐2011
Time Period Providers Average Members Rate per 1,000
2007 QTR 1 1862 82,880 44.5
2007 QTR 2 1920 83,462 43.5
2007
QTR
3
1965
83,444
42.52007 QTR 4 2032 83,391 41.0
2008 QTR 1 2044 84,380 41.3
2008 QTR 2 2098 85,632 40.8
2008 QTR 3 2095 86,783 41.4
2008 QTR 4 2186 88,024 40.3
2009 QTR 1 2195 90,866 41.4
2009 QTR 2 2262 94,059 41.6
2009 QTR 3 2375 96,178 40.5
2009 QTR 4 2433 97,444 40.1
2010 QTR 1 2467 98,287 39.8
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Time Period Providers Average Members Rate per 1,000
2010 QTR 2 2503 99,162 39.6
2010 QTR 3 2584 99,813 38.6
2010 QTR 4 2584 99,974 38.7
2011 QTR 1 2594 100,362 38.7
2011 QTR 2 2607 100,922 38.7
2011 QTR 3 2659 100,952 38.0
2011 QTR 4 2621 100,675 38.4
Figure 11. Ratio of NH Medicaid Child Beneficiaries to Active In‐State Pediatricians, CY 2007‐2011
Time Period Providers 0 to 18 members Rate per 1,000
2007 QTR 1 243 62,498 257.2
2007 QTR 2 245 63,029 257.3
2007 QTR 3 245 62,907 256.8
2007 QTR 4 250 62,848 251.4
2008 QTR 1 267 63,451 237.6
2008 QTR 2 252 64,409 255.6
2008 QTR 3 247 65,159 263.8
2008 QTR 4 255 65,967 258.7
2009 QTR 1 250 67,894 271.6
2009 QTR 2 255 70,351 275.9
2009 QTR 3 269 71,983 267.6
2009 QTR
4
269
73,039
271.52010 QTR 1 266 73,589 276.7
2010 QTR 2 270 74,133 274.6
2010 QTR 3 278 74,574 268.3
2010 QTR 4 276 74,801 271.0
2011 QTR 1 277 75,106 271.1
2011 QTR 2 278 75,555 271.8
2011 QTR 3 281 75,710 269.4
2011 QTR 4 283 75,722 267.6
Figure 12. Ratio of NH Medicaid Adult Female Beneficiaries Age 18 to 64 to Active In‐State
Obstetricians/Gynecologists, CY 2007‐2011
Time Period Providers F 19 ‐ 64 Members Rate per 1,000
2007 QTR 1 169 49,295 291.7
2007 QTR
2
165
49,244
298.42007 QTR 3 163 49,510 303.7
2007 QTR 4 165 49,344 299.1
2008 QTR 1 162 49,885 307.9
2008 QTR 2 168 50,891 302.9
2008 QTR 3 167 51,444 308.0
2008 QTR 4 160 52,068 325.4
2009 QTR 1 167 53,781 322.0
2009 QTR 2 163 55,346 339.5
2009 QTR 3 168 56,338 335.3
2009 QTR 4 171 56,503 330.4
2010 QTR 1 167 56,770 339.9
2010 QTR 2 163 57,327 351.7
2010 QTR 3 168 57,780 343.9
2010 QTR 4 174 57,583 330.9
2011 QTR 1 174 57,359 329.6
2011 QTR
2
170
57,695
339.42011 QTR 3 169 57,271 338.9
2011 QTR 4 172 56,662 329.4
Figure 13. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Total Population
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 95006 248641 382 361
2007 QTR 2 86942 250387 347 350
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Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 3 82644 250333 330 351
2007 QTR 4 90983 250172 364 360
2008 QTR 1 98124 253141 388 366
2008 QTR 2 91854 256897 358 361
2008 QTR 3 90591 260349 348 370
2008 QTR 4 96665 264072 366 362
2009 QTR 1 109231 272598 401 378
2009 QTR
2
110575
282178
392 3952009 QTR 3 105470 288533 366 389
2009 QTR 4 117563 292332 402 398
2010 QTR 1 119994 294860 407 384
2010 QTR 2 113349 297486 381 385
2010 QTR 3 107316 299440 358 381
2010 QTR 4 112532 299922 375 371
2011 QTR 1 118182 301086 393 371
2011 QTR 2 112857 302767 373 376
2011 QTR 3 104176 302856 344 366
2011 QTR 4 112266 302025 372 368
Figure 14. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY
2007
‐2011:
Children,
Blind
and
Disabled
Aid
Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 793 1565 507 472
2007 QTR 2 766 1579 485 462
2007 QTR 3 611 1545 395 436
2007 QTR 4 709 1574 450 462
2008 QTR 1 762 1607 474 442
2008 QTR 2 775 1691 458 437
2008 QTR 3 681 1739 392 432
2008 QTR 4 621 1797 346 355
2009 QTR 1 752 1813 415 386
2009 QTR 2 853 1853 460 439
2009 QTR 3 750 1856 404 446
2009 QTR 4 920 1885 488 501
2010 QTR 1 878 1814 484 451
2010 QTR
2
775
1788
433 4132010 QTR 3 707 1791 395 436
2010 QTR 4 784 1838 427 438
2011 QTR 1 743 1795 414 385
2011 QTR 2 809 1832 442 421
2011 QTR 3 671 1791 375 413
2011 QTR 4 843 1819 463 476
Figure 15. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Children, Children and Families Aid Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 60965 180123 338 309
2007 QTR 2 53953 181565 297 300
2007 QTR 3 48844 181344 269 300
2007 QTR
4
57054
181148
315 3092008 QTR 1 62666 182886 343 313
2008 QTR 2 56420 185637 304 307
2008 QTR 3 53514 188016 285 317
2008 QTR 4 59431 190435 312 306
2009 QTR 1 69033 196269 352 322
2009 QTR 2 67568 203568 332 335
2009 QTR 3 60991 208680 292 325
2009 QTR 4 72941 211791 344 338
2010 QTR 1 74682 213575 350 320
2010 QTR 2 68549 215267 318 322
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Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2010 QTR 3 62693 216779 289 322
2010 QTR 4 69305 217350 319 312
2011 QTR 1 74702 218364 342 313
2011 QTR 2 70082 219597 319 323
2011 QTR 3 62464 220350 283 316
2011 QTR 4 71122 220342 323 316
Figure 16. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Children, Foster Care Aid Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 1928 5806 332 319
2007 QTR 2 1853 5942 312 309
2007 QTR 3 1575 5831 270 289
2007 QTR 4 1825 5821 314 310
2008 QTR 1 1947 5859 332 319
2008 QTR 2 1964 5899 333 330
2008 QTR 3 1724 5723 301 322
2008 QTR 4 1725 5670 304 301
2009 QTR 1 1955 5600 349 335
2009 QTR 2 1934 5633 343 340
2009 QTR 3 1738 5414 321 343
2009 QTR
4
1925
5441
354 3502010 QTR 1 1841 5378 342 328
2010 QTR 2 1735 5344 325 322
2010 QTR 3 1689 5152 328 350
2010 QTR 4 1810 5216 347 343
2011 QTR 1 1813 5160 351 337
2011 QTR 2 1891 5235 361 358
2011 QTR 3 1568 4990 314 336
2011 QTR 4 1664 5004 333 329
Figure 17. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Adults, Aged Aid Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 956 2015 474 498
2007 QTR
2
970
2003
484 4912007 QTR 3 1074 2042 526 510
2007 QTR 4 1084 2070 524 509
2008 QTR 1 1056 2138 494 519
2008 QTR 2 1152 2134 540 547
2008 QTR 3 1167 2170 538 522
2008 QTR 4 1223 2239 546 531
2009 QTR 1 1287 2280 564 593
2009 QTR 2 1315 2300 572 580
2009 QTR 3 1388 2329 596 578
2009 QTR 4 1426 2336 610 593
2010 QTR 1 1386 2376 583 613
2010 QTR 2 1429 2405 594 602
2010 QTR 3 1537 2446 628 610
2010 QTR 4 1492 2479 602 585
2011 QTR 1 1378 2544 542 569
2011 QTR 2 1424 2546 559 567
2011 QTR 3 1383 2652 521 506
2011 QTR 4 1625 2705 601 584
Figure 18. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Adults, Blind and Disabled Aid Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 11172 21241 526 533
2007 QTR 2 11037 21713 508 524
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Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 3 12127 22052 550 532
2007 QTR 4 12171 22458 542 537
2008 QTR 1 12502 23046 542 550
2008 QTR 2 12587 23682 532 548
2008 QTR 3 13842 24307 569 551
2008 QTR 4 13768 25063 549 544
2009 QTR 1 14572 25958 561 569
2009 QTR
2
15464
26695
579 5982009 QTR 3 17183 27348 628 608
2009 QTR 4 17137 27471 624 618
2010 QTR 1 17493 27860 628 637
2010 QTR 2 16967 28199 602 621
2010 QTR 3 17593 28463 618 598
2010 QTR 4 17140 28727 597 591
2011 QTR 1 17252 29105 593 601
2011 QTR 2 17031 29615 575 593
2011 QTR 3 17232 29835 578 559
2011 QTR 4 17128 29858 574 568
Figure 19. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Adults, Families and Children
Time Period
Visits
Member
Months
Rate
per
1,000 Adjusted
Rate
per
1,000
2007 QTR 1 19192 37891 507 501
2007 QTR 2 18362 37585 489 485
2007 QTR 3 18413 37518 491 492
2007 QTR 4 18140 37101 489 497
2008 QTR 1 19191 37605 510 505
2008 QTR 2 18956 37854 501 497
2008 QTR 3 19663 38393 512 513
2008 QTR 4 19896 38868 512 521
2009 QTR 1 21632 40678 532 526
2009 QTR 2 23441 42129 556 553
2009 QTR 3 23420 42904 546 547
2009 QTR 4 23214 43408 535 544
2010 QTR 1 23714 43857 541 535
2010 QTR 2 23894 44482 537 533
2010 QTR 3 23097 44803 516 516
2010 QTR 4 22001 44305 497 505
2011 QTR 1 22294 44115 505 500
2011 QTR 2 21620 43939 492 489
2011 QTR 3 20857 43234 482 483
2011 QTR 4 19884 42294 470 478
Figure 20. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Metropolitan Areas
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 55229 135660 407 385
2007 QTR 2 50733 136451 372 374
2007 QTR 3 48469 136818 354 376
2007 QTR 4 53232 137148 388 385
2008 QTR 1 57652 138497 416 394
2008 QTR 2 54524 140389 388 391
2008 QTR 3 52955 142363 372 395
2008 QTR 4 56662 144815 391 388
2009 QTR 1 64205 149621 429 406
2009 QTR 2 64932 155774 417 420
2009 QTR 3 62730 159393 394 418
2009 QTR 4 70363 161634 435 431
2010 QTR 1 70953 163264 435 411
2010 QTR 2 67423 164779 409 412
2010 QTR 3 63938 166623 384 408
2010 QTR 4 66462 167439 397 393
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Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2011 QTR 1 69820 168346 415 392
2011 QTR 2 67126 169531 396 399
2011 QTR 3 62117 169878 366 388
2011 QTR 4 67274 170333 395 391
Figure 21. Seasonally Adjusted Physician/APRN/Clinic Utilization per 1,000 NH Medicaid
Beneficiaries, CY
2007
‐2011:
Non
‐Metropolitan
Areas
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 39537 105344 375 353
2007 QTR 2 35953 106376 338 342
2007 QTR 3 33930 105891 320 341
2007 QTR 4 37521 105642 355 351
2008 QTR 1 40227 106982 376 354
2008 QTR 2 37075 108853 341 345
2008 QTR 3 37317 110061 339 361
2008 QTR 4 39773 111271 357 353
2009 QTR 1 44812 114750 391 367
2009 QTR 2 45414 118093 385 389
2009 QTR 3 42562 120344 354 377
2009 QTR 4 46958 121467 387 382
2010 QTR 1 48819 122591 398 375
2010 QTR
2
45668
123685
369 3742010 QTR 3 43136 124270 347 370
2010 QTR 4 45836 124819 367 363
2011 QTR 1 48149 125751 383 360
2011 QTR 2 45523 127098 358 363
2011 QTR 3 41811 127623 328 349
2011 QTR 4 44787 128061 350 346
Figure 22. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Total
Population
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 5185 248641 21 18
2007 QTR 2 4257 250387 17 18
2007 QTR 3 3502 250333 14 17
2007 QTR 4 4795 250172 19 18
2008 QTR 1 5823 253141 23 20
2008 QTR 2 4399 256897 17 18
2008 QTR 3 4189 260349 16 20
2008 QTR 4 4955 264072 19 18
2009 QTR 1 6014 272598 22 19
2009 QTR 2 5467 282178 19 20
2009 QTR 3 4603 288533 16 19
2009 QTR 4 6727 292332 23 22
2010 QTR 1 6283 294860 21 18
2010 QTR 2 5144 297486 17 18
2010 QTR 3 4479 299440 15 18
2010 QTR 4 5359 299922 18 17
2011 QTR 1 6047 301086 20 17
2011 QTR
2
5749
302767
19 202011 QTR 3 4481 302856 15 18
2011 QTR 4 5978 302025 20 19
Figure 23. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Children,
Children and Families Aid Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 3538 180123 20 16
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2007 QTR 2 2691 181565 15 16
2007 QTR 3 2032 181344 11 15
2007 QTR 4 3222 181148 18 17
2008 QTR 1 3920 182886 21 17
2008 QTR 2 2754 185637 15 16
2008 QTR 3 2529 188016 13 18
2008 QTR 4 3048 190435 16 15
2009 QTR 1 4091 196269 21 17
2009 QTR
2
3532
203568
17 182009 QTR 3 2704 208680 13 17
2009 QTR 4 4472 211791 21 20
2010 QTR 1 4204 213575 20 16
2010 QTR 2 3186 215267 15 16
2010 QTR 3 2587 216779 12 16
2010 QTR 4 3356 217350 15 14
2011 QTR 1 4202 218364 19 15
2011 QTR 2 3803 219597 17 18
2011 QTR 3 2725 220350 12 16
2011 QTR 4 3969 220342 18 17
Figure 24. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Adults,
Blind and
Disabled
Aid
Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 505 21241 24 24
2007 QTR 2 525 21713 24 25
2007 QTR 3 563 22052 26 25
2007 QTR 4 537 22458 24 23
2008 QTR 1 635 23046 28 27
2008 QTR 2 555 23682 23 25
2008 QTR 3 626 24307 26 25
2008 QTR 4 650 25063 26 25
2009 QTR 1 630 25958 24 24
2009 QTR 2 693 26695 26 27
2009 QTR 3 756 27348 28 27
2009 QTR 4 846 27471 31 30
2010 QTR 1 809 27860 29 29
2010 QTR
2
718
28199
25 272010 QTR 3 781 28463 27 27
2010 QTR 4 741 28727 26 25
2011 QTR 1 660 29105 23 23
2011 QTR 2 742 29615 25 26
2011 QTR 3 676 29835 23 22
2011 QTR 4 767 29858 26 25
Figure 25. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Adults,
Children and Families Aid Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 1057 37891 28 26
2007 QTR 2 972 37585 26 26
2007 QTR
3
850
37518
23 252007 QTR 4 953 37101 26 25
2008 QTR 1 1166 37605 31 29
2008 QTR 2 994 37854 26 27
2008 QTR 3 966 38393 25 28
2008 QTR 4 1160 38868 30 28
2009 QTR 1 1186 40678 29 27
2009 QTR 2 1151 42129 27 28
2009 QTR 3 1086 42904 25 28
2009 QTR 4 1316 43408 30 29
2010 QTR 1 1170 43857 27 25
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Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2010 QTR 2 1164 44482 26 27
2010 QTR 3 1048 44803 23 26
2010 QTR 4 1186 44305 27 26
2011 QTR 1 1099 44115 25 23
2011 QTR 2 1122 43939 26 26
2011 QTR 3 1027 43234 24 26
2011 QTR 4 1148 42294 27 26
Figure 26. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011:
Metropolitan Areas
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 2595 135660 19 16
2007 QTR 2 2079 136451 15 16
2007 QTR 3 1666 136818 12 15
2007 QTR 4 2353 137148 17 16
2008 QTR 1 3027 138497 22 18
2008 QTR 2 2214 140389 16 17
2008 QTR 3 2109 142363 15 18
2008 QTR 4 2443 144815 17 16
2009 QTR 1 3130 149621 21 18
2009 QTR 2 2832 155774 18 19
2009 QTR 3 2401 159393 15 19
2009 QTR 4 3585 161634 22 21
2010 QTR 1 3342 163264 20 17
2010 QTR 2 2702 164779 16 17
2010 QTR 3 2424 166623 15 18
2010 QTR 4 2988 167439 18 17
2011 QTR 1 3371 168346 20 17
2011 QTR 2 3349 169531 20 21
2011 QTR 3 2621 169878 15 19
2011 QTR 4 3514 170333 21 19
Figure 27. Seasonally Adjusted Emergency Department Utilization for Conditions Potentially
Treatable in Primary Care per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Non‐
Metropolitan Areas
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 2575 105344 24 21
2007 QTR 2 2162 106376 20 21
2007 QTR 3 1817 105891 17 21
2007 QTR 4 2420 105642 23 22
2008 QTR 1 2781 106982 26 22
2008 QTR 2 2169 108853 20 21
2008 QTR 3 2057 110061 19 23
2008 QTR 4 2491 111271 22 21
2009 QTR 1 2874 114750 25 21
2009 QTR 2 2618 118093 22 23
2009 QTR 3 2189 120344 18 22
2009 QTR 4 3122 121467 26 24
2010 QTR 1 2920 122591 24 20
2010 QTR
2
2425
123685
20 202010 QTR 3 2039 124270 16 20
2010 QTR 4 2358 124819 19 18
2011 QTR 1 2658 125751 21 18
2011 QTR 2 2385 127098 19 20
2011 QTR 3 1844 127623 14 17
2011 QTR 4 2441 128061 19 18
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Figure 28. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Total Population
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 17222 248641 69 68
2007 QTR 2 16748 250387 67 67
2007 QTR 3 15941 250333 64 65
2007
QTR
4
16757
250172
67 672008 QTR 1 18374 253141 73 71
2008 QTR 2 17808 256897 69 69
2008 QTR 3 18419 260349 71 72
2008 QTR 4 18006 264072 68 69
2009 QTR 1 20153 272598 74 72
2009 QTR 2 21464 282178 76 76
2009 QTR 3 20619 288533 71 73
2009 QTR 4 23071 292332 79 79
2010 QTR 1 21792 294860 74 72
2010 QTR 2 21481 297486 72 72
2010 QTR 3 21069 299440 70 72
2010 QTR 4 20200 299922 67 68
2011 QTR 1 21318 301086 71 69
2011 QTR 2 22616 302767 75 74
2011 QTR 3 21039 302856 69 71
2011 QTR
4
21087
302025
70 70
Figure 29. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Children, Blind and Disabled Aid Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 85 1565 54 51
2007 QTR 2 76 1579 48 46
2007 QTR 3 81 1545 52 58
2007 QTR 4 81 1574 51 52
2008 QTR 1 106 1607 66 62
2008 QTR 2 103 1691 61 59
2008 QTR 3 83 1739 48 53
2008 QTR 4 98 1797 55 55
2009 QTR 1 92 1813 51 48
2009 QTR
2
123
1853
66 642009 QTR 3 104 1856 56 62
2009 QTR 4 125 1885 66 67
2010 QTR 1 124 1814 68 64
2010 QTR 2 106 1788 59 57
2010 QTR 3 86 1791 48 53
2010 QTR 4 95 1838 52 52
2011 QTR 1 130 1795 72 68
2011 QTR 2 118 1832 64 62
2011 QTR 3 105 1791 59 65
2011 QTR 4 96 1819 53 53
Figure 30. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Children, Children and Families Aid Categories
Time Period
Visits
Member
Months
Rate
per
1,000 Adjusted
Rate
per
1,000
2007 QTR 1 9445 180123 52 49
2007 QTR 2 8798 181565 48 48
2007 QTR 3 7888 181344 43 47
2007 QTR 4 9037 181148 50 50
2008 QTR 1 9914 182886 54 51
2008 QTR 2 9282 185637 50 49
2008 QTR 3 9212 188016 49 53
2008 QTR 4 9140 190435 48 48
2009 QTR 1 11013 196269 56 53
2009 QTR 2 11527 203568 57 56
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Business
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Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2009 QTR 3 10353 208680 50 54
2009 QTR 4 12879 211791 61 61
2010 QTR 1 11870 213575 56 52
2010 QTR 2 11277 215267 52 52
2010 QTR 3 10210 216779 47 51
2010 QTR 4 10290 217350 47 47
2011 QTR 1 11796 218364 54 51
2011 QTR
2
12438
219597
57 562011 QTR 3 10815 220350 49 53
2011 QTR 4 11601 220342 53 53
Figure 31. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Children, Foster Care Aid Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 271 5806 47 46
2007 QTR 2 287 5942 48 46
2007 QTR 3 302 5831 52 54
2007 QTR 4 299 5821 51 53
2008 QTR 1 309 5859 53 52
2008 QTR 2 327 5899 55 52
2008 QTR 3 285 5723 50 52
2008 QTR
4
268
5670
47 492009 QTR 1 319 5600 57 56
2009 QTR 2 326 5633 58 55
2009 QTR 3 245 5414 45 47
2009 QTR 4 277 5441 51 52
2010 QTR 1 272 5378 51 50
2010 QTR 2 293 5344 55 52
2010 QTR 3 249 5152 48 51
2010 QTR 4 254 5216 49 50
2011 QTR 1 258 5160 50 49
2011 QTR 2 257 5235 49 46
2011 QTR 3 207 4990 41 43
2011 QTR 4 208 5004 42 43
Figure 32. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY
2007
‐2011:
Adult,
Aged
Aid
Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 70 2015 35 35
2007 QTR 2 94 2003 47 46
2007 QTR 3 92 2042 45 46
2007 QTR 4 110 2070 53 52
2008 QTR 1 120 2138 56 57
2008 QTR 2 106 2134 50 49
2008 QTR 3 102 2170 47 48
2008 QTR 4 104 2239 46 46
2009 QTR 1 128 2280 56 57
2009 QTR 2 127 2300 55 54
2009 QTR 3 117 2329 50 52
2009 QTR 4 113 2336 48 48
2010 QTR 1 126 2376 53 54
2010 QTR 2 131 2405 54 53
2010 QTR 3 133 2446 54 56
2010 QTR 4 140 2479 56 56
2011 QTR 1 125 2544 49 50
2011 QTR 2 120 2546 47 46
2011 QTR 3 143 2652 54 55
2011 QTR 4 157 2705 58 57
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Business
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Figure 33. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Adult, Blind and Disabled Aid Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 2541 21241 120 127
2007 QTR 2 2780 21713 128 129
2007 QTR 3 2975 22052 135 125
2007
QTR
4
2728
22458
121 1242008 QTR 1 2959 23046 128 136
2008 QTR 2 3136 23682 132 133
2008 QTR 3 3597 24307 148 137
2008 QTR 4 3335 25063 133 135
2009 QTR 1 3264 25958 126 133
2009 QTR 2 3714 26695 139 140
2009 QTR 3 4126 27348 151 140
2009 QTR 4 3932 27471 143 146
2010 QTR 1 4013 27860 144 153
2010 QTR 2 4154 28199 147 148
2010 QTR 3 4478 28463 157 146
2010 QTR 4 4088 28727 142 145
2011 QTR 1 3754 29105 129 137
2011 QTR 2 4216 29615 142 143
2011 QTR 3 4338 29835 145 135
2011 QTR
4
3980
29858
133 136
Figure 34. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Adult, Families and Children Aid Categories
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 4810 37891 127 127
2007 QTR 2 4713 37585 125 126
2007 QTR 3 4603 37518 123 121
2007 QTR 4 4502 37101 121 123
2008 QTR 1 4966 37605 132 132
2008 QTR 2 4854 37854 128 128
2008 QTR 3 5140 38393 134 132
2008 QTR 4 5061 38868 130 132
2009 QTR 1 5337 40678 131 131
2009 QTR
2
5647
42129
134 1342009 QTR 3 5674 42904 132 130
2009 QTR 4 5745 43408 132 135
2010 QTR 1 5387 43857 123 123
2010 QTR 2 5520 44482 124 124
2010 QTR 3 5913 44803 132 130
2010 QTR 4 5333 44305 120 122
2011 QTR 1 5255 44115 119 119
2011 QTR 2 5467 43939 124 125
2011 QTR 3 5431 43234 126 124
2011 QTR 4 5045 42294 119 121
Figure 35. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Metropolitan Counties
Time Period
Visits
Member
Months
Rate
per
1,000 Adjusted
Rate
per
1,000
2007 QTR 1 9230 135660 68 66
2007 QTR 2 8834 136451 65 64
2007 QTR 3 8178 136818 60 61
2007 QTR 4 8884 137148 65 65
2008 QTR 1 10058 138497 73 71
2008 QTR 2 9807 140389 70 69
2008 QTR 3 10160 142363 71 73
2008 QTR 4 9707 144815 67 67
2009 QTR 1 11032 149621 74 72
2009 QTR 2 11803 155774 76 75
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Business
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Policy
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Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2009 QTR 3 11477 159393 72 74
2009 QTR 4 13003 161634 80 81
2010 QTR 1 12204 163264 75 73
2010 QTR 2 12200 164779 74 74
2010 QTR 3 12070 166623 72 74
2010 QTR 4 11744 167439 70 70
2011 QTR 1 12220 168346 73 71
2011 QTR
2
13275
169531
78 782011 QTR 3 12330 169878 73 75
2011 QTR 4 12486 170333 73 73
Figure 36. Seasonally Adjusted Total Emergency Department Utilization per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2011: Non‐Metropolitan Counties
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 7929 105344 75 73
2007 QTR 2 7847 106376 74 73
2007 QTR 3 7680 105891 73 74
2007 QTR 4 7810 105642 74 75
2008 QTR 1 8262 106982 77 75
2008 QTR 2 7932 108853 73 73
2008 QTR 3 8193 110061 74 76
2008 QTR
4
8228
111271
74 752009 QTR 1 9070 114750 79 77
2009 QTR 2 9600 118093 81 81
2009 QTR 3 9094 120344 76 77
2009 QTR 4 10012 121467 82 83
2010 QTR 1 9519 122591 78 75
2010 QTR 2 9198 123685 74 74
2010 QTR 3 8914 124270 72 73
2010 QTR 4 8401 124819 67 68
2011 QTR 1 9026 125751 72 70
2011 QTR 2 9289 127098 73 73
2011 QTR 3 8636 127623 68 69
2011 QTR 4 8541 128061 67 67
Figure 37. Seasonally
Adjusted
Inpatient
Hospital
Utilization
for
Ambulatory
Care
Sensitive
Conditions per 1,000 NH Medicaid Beneficiaries, CY 2007‐2011: Total Population
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 194 248641 0.78 0.63
2007 QTR 2 148 250387 0.59 0.68
2007 QTR 3 121 250333 0.48 0.55
2007 QTR 4 175 250172 0.70 0.69
2008 QTR 1 196 253141 0.77 0.62
2008 QTR 2 140 256897 0.54 0.62
2008 QTR 3 178 260349 0.68 0.78
2008 QTR 4 161 264072 0.61 0.60
2009 QTR 1 213 272598 0.78 0.63
2009 QTR 2 152 282178 0.54 0.62
2009 QTR 3 146 288533 0.51 0.58
2009 QTR
4
190
292332
0.65 0.642010 QTR 1 210 294860 0.71 0.57
2010 QTR 2 143 297486 0.48 0.55
2010 QTR 3 146 299440 0.49 0.56
2010 QTR 4 161 299922 0.54 0.53
2011 QTR 1 182 301086 0.60 0.49
2011 QTR 2 164 302767 0.54 0.62
2011 QTR 3 130 302856 0.43 0.49
2011 QTR 4 214 302025 0.71 0.70
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Figure 38. Seasonally Adjusted Inpatient Hospital Utilization per 1,000 NH Medicaid Beneficiaries, CY
2007‐2011: Total Population
Time Period Visits Member Months Rate per 1,000 Adjusted Rate per 1,000
2007 QTR 1 2682 248641 11 10
2007 QTR 2 2905 250387 12 12
2007 QTR 3 2756 250333 11 11
2007
QTR
4
2571
250172
10 112008 QTR 1 2795 253141 11 11
2008 QTR 2 2639 256897 10 10
2008 QTR 3 2869 260349 11 11
2008 QTR 4 2580 264072 10 10
2009 QTR 1 2978 272598 11 10
2009 QTR 2 2841 282178 10 10
2009 QTR 3 2952 288533 10 10
2009 QTR 4 2901 292332 10 10
2010 QTR 1 3136 294860 11 10
2010 QTR 2 2884 297479 10 10
2010 QTR 3 2918 299413 10 10
2010 QTR 4 2933 299880 10 10
2011 QTR 1 2995 301002 10 10
2011 QTR 2 3000 302620 10 10
2011 QTR 3 2859 302696 9 9
2011 QTR
4
2878
301843
10 10Note: excludes newborns Figure 39. Percent of Continuously Enrolled NH Medicaid Beneficiaries With Six or More Well‐Child
Visits in the First 15 Months of Life, CY 2007‐2011: Total Population
Time Period 6+ Visits Members Percent
CY 2007 2558 3418 74.8%
CY 2008 2632 3478 75.7%
CY 2009 2907 3817 76.2%
CY 2010 3103 4003 77.5%
CY 2011 3062 3969 77.1%
Figure 40. Percent of Continuously Enrolled NH Medicaid Beneficiaries With Six or More Well‐Child
Visits in
the
First
15
Months
of
Life,
CY
2007
‐2011:
Metropolitan
Counties
Time Period 6+ Visits Members Percent
CY 2007 1359 1868 72.8%
CY 2008 1452 1965 73.9%
CY 2009 1570 2105 74.6%
CY 2010 1711 2222 77.0%
CY 2011 1711 2233 76.6%
Figure 41. Percent of Continuously Enrolled NH Medicaid Beneficiaries With Six or More Well‐Child
Visits in the First 15 Months of Life, CY 2007‐2011: Non‐Metropolitan Counties
Time Period 6+ Visits Members Percent
CY 2007 1114 1433 77.7%
CY 2008 1088 1397 77.9%
CY 2009 1236 1569 78.8%
CY 2010 1305 1655 78.9%
CY 2011 1298 1664 78.0%
Figure 42. Percent of Continuously Enrolled NH Medicaid Beneficiaries in the Third Through Sixth
Years of Life With a Well‐Child Visit, CY 2007‐2011: Total Population
Time Period Members with Visit Members Percent
CY 2007 8857 12099 73.2%
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Business
and
Policy
75
CY 2008 9360 12758 73.4%
CY 2009 11033 14390 76.7%
CY 2010 11938 15552 76.8%
CY 2011 12247 15920 76.9%
Figure 43. Percent of Continuously Enrolled NH Medicaid Beneficiaries in the Third Through Sixth
Years of Life With a Well‐Child Visit, CY 2007‐2011: Metropolitan Counties
Time Period Members with Visit Members Percent
2007 4902 6582 74.5%
2008 5262 7033 74.8%
2009 6250 7952 78.6%
2010 6846 8702 78.7%
2011 7159 9108 78.6%
Figure 44. Percent of Continuously Enrolled NH Medicaid Beneficiaries in the Third Through Sixth
Years of Life With a Well‐Child Visit, CY 2007‐2011: Non‐Metropolitan Counties
Time Period Members with Visit Members Percent
2007 3675 5144 71.4%
2008 3823 5339 71.6%
2009 4459 5971 74.7%
2010
4821
6471
74.5%2011 4970 6630 75.0%
Figure 45. Percent of Continuously Enrolled Adolescent NH Medicaid Beneficiaries With a Well‐Care
Visit, CY 2007‐2011: Total Population
Time Period Members with Visit Members Percent
CY 2007 9559 20356 47.0%
CY 2008 8671 18208 47.6%
CY 2009 10292 20102 51.2%
CY 2010 10684 21007 50.9%
CY 2011 10588 20850 50.8%
Figure 46. Percent of Continuously Enrolled Adolescent NH Medicaid Beneficiaries With a Well‐Care
Visit,
CY
2007‐
2011:
Metropolitan
Counties
Time Period Members with Visit Members Percent
CY 2007 5267 10730 49.1%
CY 2008 4834 9751 49.6%
CY 2009 5808 10717 54.2%
CY 2010 6124 11450 53.5%
CY 2011 5942 11406 52.1%
Figure 47. Percent of Continuously Enrolled Adolescent NH Medicaid Beneficiaries With a Well‐Care
Visit, CY 2007‐2011: Non‐Metropolitan Counties
Time Period Members with Visit Members Percent
CY 2007 4282 9196 46.6%
CY 2008 3824 8080 47.3%
CY 2009 4474 8932 50.1%
CY 2010
4554
9211
49.4%
CY 2011 4638 9294 49.9%
Figure 48. Percent of Continuously Enrolled NH Medicaid Child Beneficiaries With a Preventive or
Other Ambulatory Service, SFY 2007‐2011 by Age: 0 to 11 Months
Time Period Percent with Visit
SFY 2007 98.5%
SFY 2008 98.2%
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Business
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Policy
76
SFY 2009 98.7%
SFY 2010 97.9%
SFY 2011 97.4%
Figure 49. Percent of Continuously Enrolled NH Medicaid Child Beneficiaries With a Preventive or
Other
Ambulatory
Service,
SFY
2007‐
2011
by
Age:
12
to
24
Months
Time Period Percent with Visit
SFY 2007 97.6%
SFY 2008 97.5%
SFY 2009 98.0%
SFY 2010 97.4%
SFY 2011 96.6%
Figure 50. Percent of Continuously Enrolled NH Medicaid Child Beneficiaries With a Preventive or
Other Ambulatory Service, SFY 2007‐2011 by Age: 25 Months to 6 Years
Time Period Percent with Visit
SFY 2007 88.9%
SFY 2008
88.9%
SFY 2009 90.0%
SFY 2010 90.8%
SFY 2011 89.8%
Figure 51. Percent of Continuously Enrolled NH Medicaid Child Beneficiaries With a Preventive or
Other Ambulatory Service, SFY 2007‐2011 by Age: 7 to 11 Years
Time Period Percent with Visit
SFY 2007 86.6%
SFY 2008 85.9%
SFY 2009 87.2%
SFY 2010 88.1%
SFY 2011 87.5%
Figure 52. Percent of Continuously Enrolled NH Medicaid Child Beneficiaries With a Preventive or
Other Ambulatory Service, SFY 2007‐2011 by Age: 12 to 18 Years
Time Period Percent with Visit
SFY 2007 91.2%
SFY 2008 90.9%
SFY 2009 92.0%
SFY 2010 93.2%
SFY 2011 93.2%
Figure 53. Percent
of
Continuously
Enrolled
NH
Medicaid
Adult
Beneficiaries
With
a Preventive
or
Other Ambulatory Service, SFY 2007‐2011 by Age: 20 to 44 Years
Time Period Members with Visit Members Percent
CY 2004 7,184 8,454 85.0
CY 2005 7,319 8,850 82.7
CY 2006 7,834 8,824 88.8
CY 2007 7,615 8,718 87.3
CY 2008 7,913 9,041 87.5
CY 2009 9,165 10,465 87.6
CY 2010 9,755 11,377 85.7
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Business
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Policy
77
Figure 54. Percent of Continuously Enrolled NH Medicaid Adult Beneficiaries With a Preventive or
Other Ambulatory Service, SFY 2007‐2011 by Age: 45 to 64 Years
Time Period Numerator Denominator Percent
CY 2004 2,865 3,196 89.6
CY 2005 3,016 3,424 88.1
CY 2006 3,230 3,491 92.5
CY
2007
3,389
3,642
93.1CY 2008 3,683 3,949 93.3
CY 2009 4,160 4,523 92.0
CY 2010 4,421 4,770 92.7
Figure 55. Beneficiary Requests for Assistance Accessing Providers per 1,000 NH Medicaid
Beneficiaries, CY 2007‐2012: Total Population
Time Period Calls Member Months Rate per 1,000
2007 QTR 1 674 248,641 2.7
2007 QTR 2 489 250,387 2.0
2007 QTR 3 422 250,333 1.7
2007 QTR 4 416 250,172 1.7
2008 QTR 1 481 253,141 1.9
2008 QTR 2 472 256,897 1.8
2008 QTR 3 499 260,349 1.9
2008 QTR 4 610 264,072 2.3
2009 QTR 1 667 272,598 2.4
2009 QTR 2 696 282,178 2.5
2009 QTR 3 748 288,533 2.6
2009 QTR 4 638 292,332 2.2
2010 QTR 1 613 294,860 2.1
2010 QTR 2 714 297,486 2.4
2010 QTR 3 702 299,440 2.3
2010 QTR 4 495 299,922 1.7
2011 QTR 1 678 301,086 2.3
2011 QTR 2 656 302,767 2.2
2011 QTR 3 703 302,856 2.3
2011 QTR 4 792 302,025 2.6
2012 QTR 1 673 300,366 2.2
Figure 56. Beneficiary
Requests
for
Assistance
Accessing
Providers
per
1,000
NH
Medicaid
Beneficiaries, CY 2007‐2012: Metropolitan Counties
Time Period Calls Member Months Rate per 1,000
2007 QTR 1 454 135,660 3.3
2007 QTR 2 329 136,451 2.4
2007 QTR 3 285 136,818 2.1
2007 QTR 4 303 137,148 2.2
2008 QTR 1 333 138,497 2.4
2008 QTR 2 349 140,389 2.5
2008 QTR 3 348 142,363 2.4
2008 QTR 4 431 144,815 3.0
2009 QTR 1 471 149,621 3.1
2009 QTR 2 494 155,774 3.2
2009 QTR 3 498 159,393 3.1
2009 QTR
4
492
161,634
3.02010 QTR 1 422 163,264 2.6
2010 QTR 2 496 164,779 3.0
2010 QTR 3 488 166,623 2.9
2010 QTR 4 348 167,439 2.1
2011 QTR 1 460 168,346 2.7
2011 QTR 2 423 169,531 2.5
2011 QTR 3 475 169,878 2.8
2011 QTR 4 470 170,333 2.8
2012 QTR 1 458 170,262 2.7
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